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General NPI Number Information
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NPI Number | 1467000620
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Entity Type | Individual
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Provider Name | KAITLYN NICOLE RYBACKI
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Gender | Female
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 212 MARTER AVE
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3114
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Country | US
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Telephone | 856-291-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 1165 MAPLE AVE
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City | ATCO
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State | NJ
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Zip | 08004-1406
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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 | 46TR00877400
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License Number State | NJ
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