Provider Demographics
NPI:1497336846
Name:RAITEN, ANJELICA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANJELICA
Middle Name:
Last Name:RAITEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:ANJELICA
Other - Middle Name:
Other - Last Name:LAUFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8 CUMMINGS CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4311
Mailing Address - Country:US
Mailing Address - Phone:908-770-4966
Mailing Address - Fax:
Practice Address - Street 1:8 CUMMINGS CT
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4311
Practice Address - Country:US
Practice Address - Phone:908-770-4966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00773400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist