Provider Demographics
NPI:1770162257
Name:LIBUNAO, RAPHAELA JANNA FERNANDEZ (OTR/L)
Entity type:Individual
Prefix:MS
First Name:RAPHAELA JANNA
Middle Name:FERNANDEZ
Last Name:LIBUNAO
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 1:1102 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-2012
Mailing Address - Country:US
Mailing Address - Phone:848-467-1286
Mailing Address - Fax:
Practice Address - Street 1:1102 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-2012
Practice Address - Country:US
Practice Address - Phone:848-467-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00983200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist