Healthcare Provider Details

I. General information

NPI: 1144045030
Provider Name (Legal Business Name): NICOLETTE DESALVATORE OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FURLONG DR
MILLSTONE TOWNSHIP NJ
08535-8109
US

IV. Provider business mailing address

4 FURLONG DR
MILLSTONE TOWNSHIP NJ
08535-8109
US

V. Phone/Fax

Practice location:
  • Phone: 732-610-0502
  • Fax:
Mailing address:
  • Phone: 732-610-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number46TR01188100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: