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General NPI Number Information
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NPI Number | 1154530954
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Entity Type | Individual
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Provider Name | GREGG ALAN FRANK OTRL
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 66 SUNSET STRIP
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1345
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Country | US
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Telephone | 973-252-9292
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Fax | 973-252-9377
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Provider Business Mailing Address
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Address Line | 5 TANGLEWOOD CT
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City | RANDOLPH
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State | NJ
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Zip | 07869-4306
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Country | US
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Telephone | 973-252-9292
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Fax | 973-252-9377
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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 | TR001815
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License Number State | NJ
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