Provider Demographics
NPI:1134683410
Name:SPETGANG, JEANNA (OTR)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:SPETGANG
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 1:36 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5723
Mailing Address - Country:US
Mailing Address - Phone:732-581-9275
Mailing Address - Fax:267-790-0402
Practice Address - Street 1:132 PEARLCROFT RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3334
Practice Address - Country:US
Practice Address - Phone:609-509-2388
Practice Address - Fax:267-790-0402
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00568700225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology