Provider Demographics
NPI:1255452645
Name:CABANAS GODBOLE, MARIA MINETTE (OTR CHT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MINETTE
Last Name:CABANAS GODBOLE
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:MARIA MINETTE
Other - Middle Name:A
Other - Last Name:CABANAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR CHT
Mailing Address - Street 1:1447 ROUTE 18 STE 3
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3797
Mailing Address - Country:US
Mailing Address - Phone:732-727-7333
Mailing Address - Fax:732-908-1026
Practice Address - Street 1:4255 ROUTE 9 N
Practice Address - Street 2:BLD 5, STE A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8305
Practice Address - Country:US
Practice Address - Phone:732-727-7333
Practice Address - Fax:732-727-7333
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00203900225X00000X
NJ9711000541225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
038178Medicare ID - Type Unspecified