Healthcare Provider Details

I. General information

NPI: 1699045708
Provider Name (Legal Business Name): HENNA PRUZANSKY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHELSEA CT
LAKEWOOD NJ
08701-5345
US

IV. Provider business mailing address

14 CHELSEA CT
LAKEWOOD NJ
08701-5345
US

V. Phone/Fax

Practice location:
  • Phone: 732-901-6346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00118600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: