Healthcare Provider Details

I. General information

NPI: 1114460730
Provider Name (Legal Business Name): JESSICA WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8804 5TH AVE
BROOKLYN NY
11209-5902
US

IV. Provider business mailing address

513 WASHINGTON ST APARTMENT #2
HOBOKEN NJ
07030-4994
US

V. Phone/Fax

Practice location:
  • Phone: 718-238-7451
  • Fax:
Mailing address:
  • Phone: 908-894-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number021082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: