Provider Demographics
NPI:1033383021
Name:GURANGO, ROSSELLE POBLETE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROSSELLE
Middle Name:POBLETE
Last Name:GURANGO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5465
Mailing Address - Country:US
Mailing Address - Phone:908-686-2932
Mailing Address - Fax:
Practice Address - Street 1:1355 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5465
Practice Address - Country:US
Practice Address - Phone:908-686-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00466500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist