Provider Demographics
NPI:1477866952
Name:SESE LAVINA, CARREL GONZALES (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARREL
Middle Name:GONZALES
Last Name:SESE LAVINA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 GROVE ST UNIT E6
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3177
Mailing Address - Country:US
Mailing Address - Phone:201-889-3902
Mailing Address - Fax:
Practice Address - Street 1:1070 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3619
Practice Address - Country:US
Practice Address - Phone:973-246-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0138401-1225X00000X
NJ46TR00429200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist