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General NPI Number Information
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NPI Number | 1336660166
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Entity Type | Individual
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Provider Name | JENNIFER A INNAMORATO
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Gender | Female
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Dates
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Enumeration Date | 07/01/2017
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Last Update Date | 07/01/2017
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Provider Practice Location Address
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Address Line | 715 N BEERS ST
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City | HOLMDEL
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State | NJ
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Zip | 07733-1503
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Country | US
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Telephone | 732-847-3745
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Fax |
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Provider Business Mailing Address
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Address Line | 9 BARTLETT CT
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City | MATAWAN
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State | NJ
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Zip | 07747-9663
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Country | US
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Telephone |
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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 | 46TR00707700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT18533
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License Number State | FL
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