Provider Demographics
NPI:1396183174
Name:MERINO, TERESITA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:MERINO
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 PIERPONT ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-3230
Mailing Address - Country:US
Mailing Address - Phone:732-910-4841
Mailing Address - Fax:
Practice Address - Street 1:1219 PIERPONT ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-3230
Practice Address - Country:US
Practice Address - Phone:732-910-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00573100225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00573100OtherNJ LICENSE COMMISSION