Healthcare Provider Details

I. General information

NPI: 1225405970
Provider Name (Legal Business Name): RUTH YAACOBY MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 COUNTY ROAD SUITE 101
TENATLY NJ
07670
US

IV. Provider business mailing address

120 COUNTY ROAD SUITE 101
TENATLY NJ
07670
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-5800
  • Fax: 201-894-5990
Mailing address:
  • Phone: 201-894-5800
  • Fax: 201-894-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00251300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: