Individual
MS. STACEY MICHELE COLE-LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
175 W HUDSON AVE, ENGLEWOOD, NJ 07631-1609
(201) 871-8882
Mailing address
61 FRANKLIN ST, TENAFLY, NJ 07670-2006
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09025000
NJ
Other
Enumeration date
01/12/2019
Last updated
01/12/2019
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