Provider Demographics
NPI:1417763145
Name:SPECCHIO, AVERY (OTR/L)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:SPECCHIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-2123
Mailing Address - Country:US
Mailing Address - Phone:973-513-3555
Mailing Address - Fax:
Practice Address - Street 1:69 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1426
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01218300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist