Provider Demographics
NPI:1457611493
Name:PROFIS, MARTA (OT)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:
Last Name:PROFIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:LASKOWSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:201
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-9118
Practice Address - Street 1:11 EAGLE ROCK AVE
Practice Address - Street 2:201
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3167
Practice Address - Country:US
Practice Address - Phone:973-887-9000
Practice Address - Fax:973-887-9118
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00581900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist