Provider Demographics
NPI:1578856837
Name:AFRICA, MARY MAY J (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY MAY
Middle Name:J
Last Name:AFRICA
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 1:24 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1227
Mailing Address - Country:US
Mailing Address - Phone:973-896-8713
Mailing Address - Fax:
Practice Address - Street 1:24 MORSE AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1227
Practice Address - Country:US
Practice Address - Phone:973-896-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00617100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist