Individual provider · NPI-1

Andrea Bautista

Occupational Therapy Assistant · Newark, NJ

NPI number1619606191
StatusActive
Last updated in NPPESJun 9, 2022

Details

NPI
1619606191
Entity type
Individual (NPI-1)
Name
Andrea Bautista
Sex
Female
Sole proprietor
No
Enumeration date
Jun 9, 2022
Certification date
Jun 7, 2022
Last updated
Jun 9, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
224Z00000X Occupational Therapy Assistant46TA09143200NJYes
224Z00000X Occupational Therapy Assistant011003NY

Practice location

150 Bergen St
Newark, NJ 07103-2496

Phone 973-972-3466

Mailing address

74 Maple St Unit 711
Jersey City, NJ 07304-4266

Phone 908-487-8122

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