Provider Demographics
NPI:1407036676
Name:JAVIER-ESTOQUE, MYLA NATOZA (OTR)
Entity Type:Individual
Prefix:MS
First Name:MYLA
Middle Name:NATOZA
Last Name:JAVIER-ESTOQUE
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 1:147 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1545
Mailing Address - Country:US
Mailing Address - Phone:732-725-7469
Mailing Address - Fax:732-738-1372
Practice Address - Street 1:147 MARY AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1545
Practice Address - Country:US
Practice Address - Phone:732-725-7469
Practice Address - Fax:732-738-1372
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00417900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist