Provider Demographics
NPI:1356657605
Name:DONNELLY, JAMES VINCENT (OT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VINCENT
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 CLAREMONT AVE
Mailing Address - Street 2:#2
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-1879
Mailing Address - Country:US
Mailing Address - Phone:609-529-7194
Mailing Address - Fax:
Practice Address - Street 1:395 CLAREMONT AVE
Practice Address - Street 2:#2
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-1879
Practice Address - Country:US
Practice Address - Phone:609-529-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00329400225X00000X
NY013365-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist