Provider Demographics
NPI:1013476316
Name:KERNIZAN, VALERIE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ANN
Last Name:KERNIZAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MADISON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1543
Mailing Address - Country:US
Mailing Address - Phone:908-659-8843
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON AVE APT B
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-1543
Practice Address - Country:US
Practice Address - Phone:908-659-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2019-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023308225X00000X
NJ46TR00867700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist