Provider Demographics
NPI:1275731259
Name:HENRIKSEN, LINDA (OTR)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HENRIKSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 SUMMER AVE
Mailing Address - Street 2:APT. 2A
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-5011
Mailing Address - Country:US
Mailing Address - Phone:908-872-7733
Mailing Address - Fax:
Practice Address - Street 1:111-115 GATES AVE
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2500
Practice Address - Country:US
Practice Address - Phone:973-239-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00061700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist