Individual
MAI LAUREN MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
1 NARDONE PL, JERSEY CITY, NJ 07306-3514
(201) 792-3840
Mailing address
314 RUSSELL AVE, EDGEWATER, NJ 07020-3124
(917) 415-2536
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00613200
NJ
Other
Enumeration date
07/29/2013
Last updated
07/29/2013
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