Provider Demographics
NPI:1962947150
Name:BRESLER, AVIVA SHAYNA (OTR/L)
Entity type:Individual
Prefix:
First Name:AVIVA
Middle Name:SHAYNA
Last Name:BRESLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:AVIVA
Other - Middle Name:SHAYNA
Other - Last Name:GITTLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:744 WESTFIELD AVE
Mailing Address - Street 2:APT 203
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-5303
Mailing Address - Country:US
Mailing Address - Phone:908-910-1026
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVER AVE
Practice Address - Street 2:10C
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5657
Practice Address - Country:US
Practice Address - Phone:732-534-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00755100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist