Provider Demographics
NPI:1447227780
Name:DIVITO, MONICA L
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:DIVITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-3639
Mailing Address - Country:US
Mailing Address - Phone:856-435-6332
Mailing Address - Fax:
Practice Address - Street 1:113 LAUREL RD E
Practice Address - Street 2:SUITE 2
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1363
Practice Address - Country:US
Practice Address - Phone:856-435-6332
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00256200225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand