Healthcare Provider Details

I. General information

NPI: 1326118241
Provider Name (Legal Business Name): JAMES JOSEPH O'SHEA IV OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MAIN ST
FREEHOLD NJ
07728-2537
US

IV. Provider business mailing address

1210 GEMINI PL STE 200
COLUMBUS OH
43240-6110
US

V. Phone/Fax

Practice location:
  • Phone: 732-294-2700
  • Fax:
Mailing address:
  • Phone: 614-262-0907
  • Fax: 614-262-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007630
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: