Healthcare Provider Details

I. General information

NPI: 1235775891
Provider Name (Legal Business Name): ALISA JANET GUZMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 ROUTE 27 SUITE 1100
SOMERSET NJ
08873
US

IV. Provider business mailing address

20 TOMPKINS ROAD
OLD BRIDGE NJ
08857
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-4747
  • Fax: 732-545-4288
Mailing address:
  • Phone: 732-947-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00893700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: