Provider Demographics
NPI:1386705309
Name:BAGNATI, DANA R (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:R
Last Name:BAGNATI
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MANHEIM AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-2136
Mailing Address - Country:US
Mailing Address - Phone:856-455-9700
Mailing Address - Fax:856-455-9797
Practice Address - Street 1:70 MANHEIM AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2136
Practice Address - Country:US
Practice Address - Phone:856-455-9700
Practice Address - Fax:856-455-9791
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00038300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ316704Medicare ID - Type Unspecified