Provider Demographics
NPI:1497056485
Name:KOPIDLOWSKI, JACLYN ANN (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:ANN
Last Name:KOPIDLOWSKI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2712
Mailing Address - Country:US
Mailing Address - Phone:973-766-3523
Mailing Address - Fax:973-928-3589
Practice Address - Street 1:265 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2712
Practice Address - Country:US
Practice Address - Phone:973-766-3523
Practice Address - Fax:973-928-3589
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00508400225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand