Provider Demographics
NPI:1699901108
Name:AGRESTO, JENNIFER (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
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
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-9639
Mailing Address - Country:US
Mailing Address - Phone:732-605-0541
Mailing Address - Fax:732-441-1422
Practice Address - Street 1:8 NATHANIEL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-9639
Practice Address - Country:US
Practice Address - Phone:732-605-0541
Practice Address - Fax:732-441-1422
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00072100225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics