Provider Demographics
NPI:1659660728
Name:TREVISANI, MARIA TERESA (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:TREVISANI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1409
Mailing Address - Country:US
Mailing Address - Phone:845-548-6693
Mailing Address - Fax:
Practice Address - Street 1:224 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1409
Practice Address - Country:US
Practice Address - Phone:845-548-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00090000225X00000X
NY0083551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist