Individual
JACQUELYN KUHN PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
579 CRANBURY RD STE C, EAST BRUNSWICK, NJ 08816-5405
(732) 432-0733
(732) 432-9131
Mailing address
PO BOX 416495, BOSTON, MA 02241-6495
(631) 580-5200
(631) 580-5222
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00610600
NJ
Other
Enumeration date
07/23/2021
Last updated
07/23/2021
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