Provider Demographics
NPI:1659049492
Name:PADDOCK, JAMIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 ROCK HILL LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2576
Mailing Address - Country:US
Mailing Address - Phone:973-970-0527
Mailing Address - Fax:
Practice Address - Street 1:15 SCHOOL RD E STE 3
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2061
Practice Address - Country:US
Practice Address - Phone:908-448-7069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09209600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant