Provider Demographics
NPI:1366780579
Name:ANCAO-MABALE, JOAN LATOGA (OTR)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:LATOGA
Last Name:ANCAO-MABALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:LATOGA
Other - Last Name:ANCAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3412 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6324
Mailing Address - Country:US
Mailing Address - Phone:973-412-5916
Mailing Address - Fax:
Practice Address - Street 1:3412 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6324
Practice Address - Country:US
Practice Address - Phone:973-412-5916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00494300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist