Provider Demographics
NPI:1184257867
Name:GIANNELLA, KATHRYN (OT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GIANNELLA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1604
Mailing Address - Country:US
Mailing Address - Phone:908-377-5685
Mailing Address - Fax:908-288-7219
Practice Address - Street 1:184 BURNS WAY
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1604
Practice Address - Country:US
Practice Address - Phone:908-377-5685
Practice Address - Fax:908-288-7219
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00835800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist