MEDICARE: MRS. JULIA M GUZMAN 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	225XP0200X	Pediatric Occupational Therapist	46TR00242200	NJ

General Provider Information

NPI Number	:	1982767851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA M GUZMAN OT

Provider Business Mailing Address
First Line	:	986 BALSAM WAY
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 BERGEN ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-3001
Country	:	US
Telephone Number	:	973-972-0186
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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