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General NPI Number Information
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NPI Number | 1700122330
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Entity Type | Individual
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Provider Name | CYNTHIA ANN COUILLARD
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Gender | Female
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 145 STATE PARK RD
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City | BLAIRSTOWN
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State | NJ
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Zip | 07825-4206
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Country | US
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Telephone | 908-459-4128
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Fax |
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Provider Business Mailing Address
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Address Line | 96 WOLFS CORNER RD
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City | NEWTON
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State | NJ
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Zip | 07860-5432
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Country | US
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Telephone | 973-383-6104
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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 | 46TA09089200
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License Number State | NJ
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