Provider Demographics
NPI:1932492345
Name:PAGNILLO, MARTHA (OTR/L)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:PAGNILLO
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 1:775 WILLICK RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1915
Mailing Address - Country:US
Mailing Address - Phone:201-725-7743
Mailing Address - Fax:
Practice Address - Street 1:750 ROUTE 10
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1131
Practice Address - Country:US
Practice Address - Phone:973-500-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NY016327-1225X00000X
FLOT16424225X00000X
NJ46TR00623800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013037300Medicaid
FL014322900Medicaid