Provider Demographics
NPI:1891974325
Name:KING, JOHN WARREN (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WARREN
Last Name:KING
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1003
Mailing Address - Country:US
Mailing Address - Phone:201-546-1265
Mailing Address - Fax:
Practice Address - Street 1:128 W GROVE ST
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1003
Practice Address - Country:US
Practice Address - Phone:201-546-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 4903225X00000X
NY007253225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist