Individual
MRS. MARTHA VANESSA JACKMAN-BIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
111-115 GATES AVE, MONTCLAIR, NJ 07042-2500
(973) 746-4616
Mailing address
8 CHARLES ST, 1, MONTCLAIR, NJ 07042-2406
(800) 530-3247
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00291700
NJ
Other
Enumeration date
08/05/2007
Last updated
08/05/2007
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