Individual
TANIA VICENTE CARBALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
178 CHESTNUT ST, KEARNY, NJ 07032-2420
(551) 580-4750
Mailing address
178 CHESTNUT ST, KEARNY, NJ 07032-2420
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR01016300
NJ
Other
Enumeration date
05/17/2022
Last updated
05/17/2022
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