Provider Demographics
NPI:1851920995
Name:DIGEROLAMO, MEGHAN GRACE (OTR)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:GRACE
Last Name:DIGEROLAMO
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 1:55 RIVERWALK PL APT 314
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-7811
Mailing Address - Country:US
Mailing Address - Phone:862-258-0007
Mailing Address - Fax:
Practice Address - Street 1:50 POLIFLY RD
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3287
Practice Address - Country:US
Practice Address - Phone:862-258-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00787300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist