Individual
MRS. COLETTE DAWN GANDOLFO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.T.A
Contact information
Practice address
536 RIDGE RD, CEDAR GROVE, NJ 07009
(973) 239-9300
Mailing address
16 VANDERVORT STREET, FLORIDA, NY 10921
(845) 651-5136
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09048800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46TA09048800
COTA
NJ
Enumeration date
03/29/2007
Last updated
07/08/2007
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