Provider Demographics
NPI:1063538262
Name:HART, JOSEPH STEPHEN (COTA-L)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:HART
Suffix:
Gender:M
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BARKER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08014-9717
Mailing Address - Country:US
Mailing Address - Phone:856-558-0484
Mailing Address - Fax:
Practice Address - Street 1:550 JESSUP RD
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1921
Practice Address - Country:US
Practice Address - Phone:856-848-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09043800224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant