Healthcare Provider Details

I. General information

NPI: 1316479611
Provider Name (Legal Business Name): KATIE HUTZAYLUK OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 N RT 31 KESSLER REHABILITATION CENTER
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

27 EDGEWOOD TER
BRIDGEWATER NJ
08807-2502
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-9035
  • Fax:
Mailing address:
  • Phone: 908-240-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00429300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: