Provider Demographics
NPI:1336746619
Name:HECHT-COSLOY, GREGG (COTA/L)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:HECHT-COSLOY
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 ROYAL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6306
Mailing Address - Country:US
Mailing Address - Phone:201-696-5395
Mailing Address - Fax:
Practice Address - Street 1:1903 ROYAL OAKS DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6306
Practice Address - Country:US
Practice Address - Phone:201-696-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09158700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant