Provider Demographics
NPI:1558014373
Name:STITIK, JEANETTE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:STITIK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CREST TER
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9312
Mailing Address - Country:US
Mailing Address - Phone:201-787-5205
Mailing Address - Fax:
Practice Address - Street 1:68 WATERFORD AVE
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-4246
Practice Address - Country:US
Practice Address - Phone:718-791-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist