Individual
MILLIE S MOGOUONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28 RICHARDS ST APT 3, NEWARK, NJ 07105-3705
(347) 489-2934
Mailing address
28 RICHARDS ST APT 3, NEWARK, NJ 07105-3705
(347) 489-2934
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006848-1
NY
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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