Individual
MICHAEL TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
128 HAWTHORNE CT, ROCKAWAY, NJ 07866-2252
(973) 907-3624
Mailing address
128 HAWTHORNE CT, ROCKAWAY, NJ 07866-2252
(973) 907-3624
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00675100
NJ
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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