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General NPI Number Information
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NPI Number | 1851731905
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Entity Type | Individual
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Provider Name | JACLYN BILANCIA MS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 4 RAILROAD AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-2724
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Country | US
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Telephone | 732-873-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 507 WARRENVILLE RD
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City | WARREN
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State | NJ
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Zip | 07059-4617
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Country | US
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Telephone | 908-917-0729
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00609600
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License Number State | NJ
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