Provider Demographics
NPI:1821167784
Name:ARREDONDO, ERVIN DAVID (OTR)
Entity Type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:DAVID
Last Name:ARREDONDO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1444
Mailing Address - Country:US
Mailing Address - Phone:732-203-2188
Mailing Address - Fax:732-203-2188
Practice Address - Street 1:56 BETHANY RD
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1444
Practice Address - Country:US
Practice Address - Phone:732-203-2188
Practice Address - Fax:732-203-2188
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00373800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist