Provider Demographics
NPI:1235257916
Name:BOCK, MARYANN (MAE, OTR)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:BOCK
Suffix:
Gender:F
Credentials:MAE, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARC ALTON CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4338
Mailing Address - Country:US
Mailing Address - Phone:732-370-0384
Mailing Address - Fax:
Practice Address - Street 1:2621 STATE HIGHWAY 138 EAST
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-9660
Practice Address - Country:US
Practice Address - Phone:732-556-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00017000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00017000OtherOT LICENSURE #