Provider Demographics
NPI:1477970960
Name:VARELA, AMY B (LMT, MMP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:B
Last Name:VARELA
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RACCOON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-3653
Mailing Address - Country:US
Mailing Address - Phone:908-442-6221
Mailing Address - Fax:609-521-9109
Practice Address - Street 1:12 RACCOON AVE
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-3653
Practice Address - Country:US
Practice Address - Phone:908-442-6221
Practice Address - Fax:609-521-9109
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00420100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist