Provider Demographics
NPI:1528254414
Name:CASTRO, GREACHY AERLLENY (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:GREACHY
Middle Name:AERLLENY
Last Name:CASTRO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:GREACHY
Other - Middle Name:AERLLENY
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:252 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2615
Mailing Address - Country:US
Mailing Address - Phone:201-340-4832
Mailing Address - Fax:
Practice Address - Street 1:65 BERGEN ST
Practice Address - Street 2:ROOM 601
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3001
Practice Address - Country:US
Practice Address - Phone:973-972-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR004046000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist