Individual
MARYBETH MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
667 PROSPECT AVE, FAIRVIEW, NJ 07022-2298
(201) 238-8844
Mailing address
667 PROSPECT AVE, FAIRVIEW, NJ 07022-2298
(201) 238-8844
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09205500
NJ
Other
Enumeration date
08/31/2022
Last updated
08/31/2022
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