Provider Demographics
NPI:1235363334
Name:WRIGHT, MAYA JESSICA (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:MAYA
Middle Name:JESSICA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MULFORD RD BLDG 6-2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-3610
Mailing Address - Country:US
Mailing Address - Phone:917-502-3180
Mailing Address - Fax:
Practice Address - Street 1:202 BERMUDA DR
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08853-4283
Practice Address - Country:US
Practice Address - Phone:917-502-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002705002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer