Provider Demographics
NPI:1538668462
Name:SHULTZ, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 WINDSOR PERRINEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-6138
Mailing Address - Country:US
Mailing Address - Phone:732-915-2820
Mailing Address - Fax:
Practice Address - Street 1:61 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3237
Practice Address - Country:US
Practice Address - Phone:609-395-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09103600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant