Provider Demographics
NPI:1033827639
Name:GREDELL, JUSTIN (OT)
Entity Type:Individual
Prefix:MRS
First Name:JUSTIN
Middle Name:
Last Name:GREDELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1401
Mailing Address - Country:US
Mailing Address - Phone:201-819-1081
Mailing Address - Fax:201-221-7844
Practice Address - Street 1:33 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1401
Practice Address - Country:US
Practice Address - Phone:201-819-1081
Practice Address - Fax:201-221-7844
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist