Provider Demographics
NPI:1760957658
Name:CABALLERO, IRENE (OT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LIVINGSTON ST STE 112
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 LIVINGSTON ST STE 112
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1739
Practice Address - Country:US
Practice Address - Phone:201-564-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45TR00443600225X00000X
NY014605-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist