Provider Demographics
NPI:1154030708
Name:YALONG, MARLISA (OTR)
Entity type:Individual
Prefix:
First Name:MARLISA
Middle Name:
Last Name:YALONG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2226
Mailing Address - Country:US
Mailing Address - Phone:201-661-3035
Mailing Address - Fax:
Practice Address - Street 1:266 HARRISTOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3354
Practice Address - Country:US
Practice Address - Phone:201-273-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01086900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist