Healthcare Provider Details

I. General information

NPI: 1235357906
Provider Name (Legal Business Name): MARY ROSE MILAR ESCAMILLAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MADISON AVE
MORRISTOWN NJ
07960-7330
US

IV. Provider business mailing address

44 CENTER GROVE RD APT A-17
RANDOLPH NJ
07869-4447
US

V. Phone/Fax

Practice location:
  • Phone: 973-734-3332
  • Fax: 973-540-1905
Mailing address:
  • Phone: 973-343-2197
  • Fax: 973-343-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00407700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: