Individual
ALYSSA JOY REQUILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 URMA PL, BLOOMFIELD, NJ 07003-3133
(973) 508-0205
Mailing address
11 URMA PL, BLOOMFIELD, NJ 07003-3133
(973) 508-0205
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
026357
NY
225X00000X
Occupational Therapist
Primary
46TR01029000
NJ
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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