MEDICARE: VANESSA STRAUB

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	224Z00000X	Occupational Therapy Assistant	46TA09083600	NJ

General Provider Information

NPI Number	:	1932654365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA STRAUB

Provider Business Mailing Address
First Line	:	920 SINCLAIR AVE
Second Line	:
City	:	LANOKA HARBOR
State	:	NJ
Zip	:	08734-2034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 SINCLAIR AVE
Second Line	:
City	:	LANOKA HARBOR
State	:	NJ
Zip	:	08734-2034
Country	:	US
Telephone Number	:	570-916-4191
Fax Number	:

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

Provider Enumeration Date	:	08/15/2016
Last Update Date	:	08/15/2016

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Directions to “ VANESSA STRAUB ” Practice Location

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