Individual
GLARISSA HEREDIA DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4712 CHESTER AVE, PHILADELPHIA, PA 19143-3513
(215) 727-4450
Mailing address
4203 CHESTER AVE, PHILADELPHIA, PA 19104-4421
(917) 361-1610
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP010106
PA
Other
Enumeration date
01/15/2025
Last updated
01/15/2025
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