Provider Demographics
NPI:1457850752
Name:JAO, HSIAOPU IRENE (OT)
Entity Type:Individual
Prefix:
First Name:HSIAOPU IRENE
Middle Name:
Last Name:JAO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ISABELLA WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5156
Mailing Address - Country:US
Mailing Address - Phone:908-822-9136
Mailing Address - Fax:
Practice Address - Street 1:274 KING GEORGE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5157
Practice Address - Country:US
Practice Address - Phone:908-484-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00079200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist