Provider Demographics
NPI:1154507341
Name:REVAK, JOAN (MS, OT, CHT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:REVAK
Suffix:
Gender:F
Credentials:MS, OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HADDONFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2746
Mailing Address - Country:US
Mailing Address - Phone:856-662-2336
Mailing Address - Fax:856-662-2667
Practice Address - Street 1:1004 HADDONFIELD RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2746
Practice Address - Country:US
Practice Address - Phone:856-662-2336
Practice Address - Fax:856-662-2667
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00028700225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand