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General NPI Number Information
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NPI Number | 1629674874
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Entity Type | Individual
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Provider Name | AMANI CANAAN
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Gender | Female
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 272 WARD AVE APT 5M
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2309
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Country | US
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Telephone | 609-770-1282
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Fax |
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Provider Business Mailing Address
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Address Line | 272 WARD AVENUE APRT 5M
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City | BORDENTOWN
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State | NJ
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Zip | 08505
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Country | US
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Telephone | 609-770-1282
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OP008512
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License Number State | PA
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