Provider Demographics
NPI:1235325044
Name:PHILLIPS, CARMELLE DOROTHY (OTR)
Entity type:Individual
Prefix:MRS
First Name:CARMELLE
Middle Name:DOROTHY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CARMELLE
Other - Middle Name:DOROTHY
Other - Last Name:DELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:328 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4428
Mailing Address - Country:US
Mailing Address - Phone:917-294-6002
Mailing Address - Fax:
Practice Address - Street 1:328 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4428
Practice Address - Country:US
Practice Address - Phone:917-294-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00366600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist