Provider Demographics
NPI:1457112351
Name:STETSENKO, KATHIE JANE (MS OTR)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:JANE
Last Name:STETSENKO
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-7319
Mailing Address - Country:US
Mailing Address - Phone:267-221-0257
Mailing Address - Fax:
Practice Address - Street 1:54 SHARP ST N
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2444
Practice Address - Country:US
Practice Address - Phone:856-327-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01160200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist