Provider Demographics
NPI:1073389573
Name:TESSER, RENEE SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SUE
Last Name:TESSER
Suffix:
Gender:F
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 1:51 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1313
Mailing Address - Country:US
Mailing Address - Phone:201-873-5572
Mailing Address - Fax:
Practice Address - Street 1:51 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1313
Practice Address - Country:US
Practice Address - Phone:201-873-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR0125500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist