Provider Demographics
NPI:1497422133
Name:CRITELLI, COURTNEY (COTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CRITELLI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUPERFINE RD
Mailing Address - Street 2:
Mailing Address - City:HIGH BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08829-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 W ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3526
Practice Address - Country:US
Practice Address - Phone:201-357-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09214600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant