Provider Demographics
NPI:1497046429
Name:JESSEN, ELIZABETH A (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JESSEN
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 1:77 BRANT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1560
Mailing Address - Country:US
Mailing Address - Phone:732-499-4540
Mailing Address - Fax:732-499-4577
Practice Address - Street 1:77 BRANT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1560
Practice Address - Country:US
Practice Address - Phone:732-499-4540
Practice Address - Fax:732-499-4577
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00177700225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics