Healthcare Provider Details

I. General information

NPI: 1861401689
Provider Name (Legal Business Name): KATHLEEN ANN RYCEK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 EGG HARBOR RD SUITE B6
SEWELL NJ
08080-2359
US

IV. Provider business mailing address

20 SUGARMAPLE LN
SICKLERVILLE NJ
08081-3037
US

V. Phone/Fax

Practice location:
  • Phone: 856-218-8050
  • Fax:
Mailing address:
  • Phone: 856-875-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00080400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: