Provider Demographics
NPI:1821841271
Name:JARAMILLO, STEPHANIE NICOLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:DAHMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DAHMER
Mailing Address - Street 1:919 N CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-5331
Mailing Address - Country:US
Mailing Address - Phone:908-721-7432
Mailing Address - Fax:
Practice Address - Street 1:3 INDUSTRIAL WAY E
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3318
Practice Address - Country:US
Practice Address - Phone:732-544-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09161800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant