Provider Demographics
NPI:1205467958
Name:GULICS, JENNA (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GULICS
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 1:44 CLYDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOPELAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-1519
Mailing Address - Country:US
Mailing Address - Phone:973-652-8949
Mailing Address - Fax:
Practice Address - Street 1:123 N UNION AVE # 204A
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2173
Practice Address - Country:US
Practice Address - Phone:908-653-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00910200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty