Provider Demographics
NPI:1316553852
Name:DE GUZMAN, TIMOTHY (OTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 NANCE RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1630
Mailing Address - Country:US
Mailing Address - Phone:973-900-1902
Mailing Address - Fax:
Practice Address - Street 1:1119 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2501
Practice Address - Country:US
Practice Address - Phone:929-333-0882
Practice Address - Fax:973-732-3981
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant