Individual provider · NPI-1

Millie S Mogouong

Occupational Therapy Assistant · Newark, NJ

NPI number1013527894
StatusActive
Last updated in NPPESAug 5, 2020

Details

NPI
1013527894
Entity type
Individual (NPI-1)
Name
Millie S Mogouong
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 5, 2020
Certification date
Aug 5, 2020
Last updated
Aug 5, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
224Z00000X Occupational Therapy Assistant006848-1NYYes

Practice location

28 Richards St Apt 3
Newark, NJ 07105-3705

Phone 347-489-2934

Mailing address

28 Richards St Apt 3
Newark, NJ 07105-3705

Phone 347-489-2934

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