Provider Demographics
NPI:1558173369
Name:AGRESTO, MIKAYLA TRACY (OTR)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:TRACY
Last Name:AGRESTO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NATHANIEL ST
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-9639
Mailing Address - Country:US
Mailing Address - Phone:732-421-4161
Mailing Address - Fax:
Practice Address - Street 1:666 PLAINSBORO RD STE 2000C
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-3048
Practice Address - Country:US
Practice Address - Phone:844-234-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01218600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist