Healthcare Provider Details

I. General information

NPI: 1689828972
Provider Name (Legal Business Name): JERYL ROBIN YAEGER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 E 17TH ST
BROOKLYN NY
11230-6011
US

IV. Provider business mailing address

1354 E 17TH ST
BROOKLYN NY
11230-6011
US

V. Phone/Fax

Practice location:
  • Phone: 718-645-9163
  • Fax: 718-998-4766
Mailing address:
  • Phone: 718-645-9163
  • Fax: 718-998-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3570-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: