Healthcare Provider Details

I. General information

NPI: 1710391859
Provider Name (Legal Business Name): MRS. ZISEL FAITLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ZISEL LIEFF OT

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CHICANOS DR
LAKEWOOD NJ
08701-1519
US

IV. Provider business mailing address

10 CHICANOS DR
LAKEWOOD NJ
08701-1519
US

V. Phone/Fax

Practice location:
  • Phone: 732-730-9569
  • Fax:
Mailing address:
  • Phone: 732-730-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00522300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00522300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: