Provider Demographics
NPI:1376816439
Name:RUTNIK, AUDRA P (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:P
Last Name:RUTNIK
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 QUARRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1339
Mailing Address - Country:US
Mailing Address - Phone:973-209-4064
Mailing Address - Fax:
Practice Address - Street 1:100 QUARRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-1339
Practice Address - Country:US
Practice Address - Phone:973-209-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00536800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist