Provider Demographics
NPI:1366885303
Name:PERSECHINO, ELLEN L (OTR)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:L
Last Name:PERSECHINO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:HOPE
Other - Last Name:LIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:42 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2208
Mailing Address - Country:US
Mailing Address - Phone:908-879-4292
Mailing Address - Fax:908-879-8422
Practice Address - Street 1:42 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2208
Practice Address - Country:US
Practice Address - Phone:908-879-4292
Practice Address - Fax:908-879-8422
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00005400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist