Healthcare Provider Details

I. General information

NPI: 1235257916
Provider Name (Legal Business Name): MARYANN BOCK MAE, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 STATE HIGHWAY 138 EAST
WALL NJ
07719-9660
US

IV. Provider business mailing address

5 MARC ALTON CT
JACKSON NJ
08527-4338
US

V. Phone/Fax

Practice location:
  • Phone: 732-556-1060
  • Fax:
Mailing address:
  • Phone: 732-370-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00017000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: