Individual
MRS. GWEN A PRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHA, OTR/L
Contact information
Practice address
620 ROUTE 23, POMPTON PLAINS, NJ 07444-1468
(973) 588-4486
Mailing address
77 CHUCKANUTT DR, OAKLAND, NJ 07436-3728
(201) 519-5251
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
46TR00068400
NJ
Other
Enumeration date
04/05/2018
Last updated
06/20/2018
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