MEDICARE: MY POTENTIAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	225100000X	Physical Therapist
3	103K00000X	Behavior Analyst
4	225X00000X	Occupational Therapist
5	106S00000X	Behavior Technician
6	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1356228563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY POTENTIAL

Provider Business Mailing Address
First Line	:	1801 E 2ND ST
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1749
Country	:	US
Telephone Number	:	908-956-1301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 E 2ND ST
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1749
Country	:	US
Telephone Number	:	908-956-1301
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ CLINICAL DIRECTOR
Name	:	MARISSA COSSOLINI
Credential	:	OTR/L
Telephone Number	:	551-697-0030

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	04/06/2026

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Directions to “MY POTENTIAL ” Practice Location

Language	Start Address	Practice Location

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