Provider Demographics
NPI:1164766523
Name:SESTITO, ANNETTE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SESTITO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 PENNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-2100
Mailing Address - Country:US
Mailing Address - Phone:856-340-1828
Mailing Address - Fax:
Practice Address - Street 1:1650 PENNFIELD DR
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-2100
Practice Address - Country:US
Practice Address - Phone:856-340-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09088600224Z00000X
MDA02137224Z00000X
PAOP007447224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant