Provider Demographics
NPI:1114299807
Name:KOWALSKI, JORDAN (OTR)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 WILLOW GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1718
Mailing Address - Country:US
Mailing Address - Phone:908-852-1430
Mailing Address - Fax:908-684-5900
Practice Address - Street 1:798 WILLOW GROVE STREET
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-1430
Practice Address - Fax:908-852-2615
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0112/00415TR/T225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology