Healthcare Provider Details

I. General information

NPI: 1326240912
Provider Name (Legal Business Name): MICHELLE HIBBERT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 TAYLOR ST
ORANGE NJ
07050-3411
US

IV. Provider business mailing address

191 TAYLOR ST
ORANGE NJ
07050-3411
US

V. Phone/Fax

Practice location:
  • Phone: 973-220-9324
  • Fax:
Mailing address:
  • Phone: 973-220-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number46TR00167400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: