Healthcare Provider Details

I. General information

NPI: 1881018141
Provider Name (Legal Business Name): NATALIE POPOWICZ MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 LAKEWOOD DR
BLOOMFIELD NJ
07003-3720
US

IV. Provider business mailing address

223 LAKEWOOD DR
BLOOMFIELD NJ
07003-3720
US

V. Phone/Fax

Practice location:
  • Phone: 201-805-1363
  • Fax:
Mailing address:
  • Phone: 201-805-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00418900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: