Individual provider · NPI-1

Timothy De Guzman, OTA

Occupational Therapy Assistant · Newark, NJ

NPI number1316553852
StatusActive
Last updated in NPPESSep 21, 2020

Details

NPI
1316553852
Entity type
Individual (NPI-1)
Name
Timothy De Guzman
Credential
OTA
Sex
Male
Sole proprietor
Yes
Enumeration date
Sep 21, 2020
Certification date
Sep 21, 2020
Last updated
Sep 21, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
224Z00000X Occupational Therapy Assistant––Yes

Practice location

1119 Broad St
Newark, NJ 07114-2501

Phone 929-333-0882 · Fax 973-732-3981

Mailing address

61 Nance Rd
West Orange, NJ 07052-1630

Phone 973-900-1902

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