MEDICARE: MRS. JESSICA ABRAHAM OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	46TR00440900	NJ

General Provider Information

NPI Number	:	1184764557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ABRAHAM OT

Provider Business Mailing Address
First Line	:	67 LACEY RD
Second Line	:	SUITE 8-12
City	:	WHITING
State	:	NJ
Zip	:	08759-2912
Country	:	US
Telephone Number	:	732-849-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 LACEY RD
Second Line	:
City	:	WHITING
State	:	NJ
Zip	:	08759-2912
Country	:	US
Telephone Number	:	732-849-0700
Fax Number	:	732-849-1088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/23/2011

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