Provider Demographics
NPI:1346520475
Name:TARTARO, JENNIFER M (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:TARTARO
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 1:301 LONGFELLOW CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4031
Mailing Address - Country:US
Mailing Address - Phone:609-404-0992
Mailing Address - Fax:
Practice Address - Street 1:432 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1372
Practice Address - Country:US
Practice Address - Phone:609-926-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00495500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist