Provider Demographics
NPI:1306071253
Name:GLADYSZ, JAIME LYNN
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LYNN
Last Name:GLADYSZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CAMELOT CT
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1586
Mailing Address - Country:US
Mailing Address - Phone:631-987-5930
Mailing Address - Fax:
Practice Address - Street 1:1450 CAMELOT CT
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077-1586
Practice Address - Country:US
Practice Address - Phone:631-987-5930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C010690225X00000X
NJ46TR00472000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist