Provider Demographics
NPI:1316479611
Name:HUTZAYLUK, KATIE (OTR)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HUTZAYLUK
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 1:27 EDGEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2502
Mailing Address - Country:US
Mailing Address - Phone:908-240-2900
Mailing Address - Fax:
Practice Address - Street 1:194 N RT 31
Practice Address - Street 2:KESSLER REHABILITATION CENTER
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-788-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00429300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist