Healthcare Provider Details

I. General information

NPI: 1306776877
Provider Name (Legal Business Name): SHELLY RUTH JASKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2679 E 64TH ST
BROOKLYN NY
11234-6815
US

IV. Provider business mailing address

2679 E 64TH ST
BROOKLYN NY
11234-6815
US

V. Phone/Fax

Practice location:
  • Phone: 347-964-9725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030624-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: