Provider Demographics
NPI:1487333530
Name:KNOWLES, JESSICA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GARWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07027-1025
Mailing Address - Country:US
Mailing Address - Phone:908-548-5004
Mailing Address - Fax:
Practice Address - Street 1:680 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6270
Practice Address - Country:US
Practice Address - Phone:908-754-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01129800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist