=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669794277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TEMEKIA DONALD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2010
-----------------------------------------------------
Last Update Date | 06/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 SALVATORE DR
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-670-2039
-----------------------------------------------------
Fax | 732-534-1799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 SALVATORE DR
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-670-2039
-----------------------------------------------------
Fax | 732-276-5882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 46TR00278800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------