Healthcare Provider Details

I. General information

NPI: 1952554321
Provider Name (Legal Business Name): MRS. JENNIFER PACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 VEEDER DR
HEWLETT NY
11557-2512
US

IV. Provider business mailing address

1239 VEEDER DR
HEWLETT NY
11557-2512
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-7255
  • Fax:
Mailing address:
  • Phone: 516-295-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number007947-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: