Provider Demographics
NPI:1467293704
Name:JAVENES, KALISTA CONCETTA (OTR/L)
Entity type:Individual
Prefix:
First Name:KALISTA
Middle Name:CONCETTA
Last Name:JAVENES
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 1:2 RIDGETOP DR
Mailing Address - Street 2:
Mailing Address - City:TOMKINS COVE
Mailing Address - State:NY
Mailing Address - Zip Code:10986-1647
Mailing Address - Country:US
Mailing Address - Phone:845-642-7571
Mailing Address - Fax:
Practice Address - Street 1:208 HARRISTOWN RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3308
Practice Address - Country:US
Practice Address - Phone:201-297-9167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01119300225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics