=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932492345
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA PAGNILLO OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2011
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 ROUTE 10
-----------------------------------------------------
City | WHIPPANY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07981-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-500-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 775 WILLICK RD
-----------------------------------------------------
City | CLARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07066-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-725-7743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 222Q00000X
-----------------------------------------------------
Taxonomy Name | Developmental Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 016327-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT16424
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 46TR00623800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------