Provider Demographics
NPI:1679166094
Name:RUEDA, CHELSEA (OTR/L)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:RUEDA
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 1:751 SOOY PLACE RD
Mailing Address - Street 2:
Mailing Address - City:VINCENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-6911
Mailing Address - Country:US
Mailing Address - Phone:848-448-7033
Mailing Address - Fax:
Practice Address - Street 1:751 SOOY PLACE RD
Practice Address - Street 2:
Practice Address - City:VINCENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08088-6911
Practice Address - Country:US
Practice Address - Phone:848-448-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00817100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist