Individual
MR. BURT MICHAEL LACIVITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S. OTR
Contact information
Practice address
81 NORTHFIELD AVE, SUITE 104, WEST ORANGE, NJ 07052-5342
(973) 325-0229
(973) 325-1105
Mailing address
141 S CENTRE ST, SOUTH ORANGE, NJ 07079-2609
(201) 923-7533
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
46TR00395600
NJ
Other
Enumeration date
02/19/2008
Last updated
09/24/2009
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