Provider Demographics
NPI:1730303512
Name:MARQUEZ, JO ANN T (OT)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:T
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:JO ANN
Other - Middle Name:
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:
Practice Address - Street 1:28-12 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3924
Practice Address - Country:US
Practice Address - Phone:201-475-8482
Practice Address - Fax:210-475-8139
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00328500225X00000X, 225X00000X
CAOT7108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist