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General NPI Number Information
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NPI Number | 1073319240
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Entity Type | Individual
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Provider Name | SO HYUN PARK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 101 N GROVE ST
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City | EAST ORANGE
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State | NJ
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Zip | 07017-4712
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Country | US
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Telephone | 973-672-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 15TH ST APT 12H
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City | FORT LEE
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State | NJ
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Zip | 07024-2027
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Country | US
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Telephone | 949-322-2227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR01158300
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License Number State | NJ
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