Provider Demographics
NPI:1497463236
Name:SALGO, SHEVIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHEVIE
Middle Name:
Last Name:SALGO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416A RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3454
Mailing Address - Country:US
Mailing Address - Phone:929-339-8562
Mailing Address - Fax:
Practice Address - Street 1:1500 AVENUE OF THE STATES
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4789
Practice Address - Country:US
Practice Address - Phone:732-961-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01078600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist