Provider Demographics
NPI:1326521832
Name:CABANTAN, ALDWIN MIRASOL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ALDWIN
Middle Name:MIRASOL
Last Name:CABANTAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2170
Mailing Address - Country:US
Mailing Address - Phone:164-664-1808
Mailing Address - Fax:
Practice Address - Street 1:1 DOWNS DR
Practice Address - Street 2:
Practice Address - City:SAYREVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08872-2170
Practice Address - Country:US
Practice Address - Phone:164-664-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00439700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist