Healthcare Provider Details

I. General information

NPI: 1871593087
Provider Name (Legal Business Name): JESSICA L VANVALKENBURG OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA L LOUNSBURY OT

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 JOHNSON ST
LAKE PEEKSKILL NY
10537-1309
US

IV. Provider business mailing address

66 JOHNSON ST
LAKE PEEKSKILL NY
10537-1309
US

V. Phone/Fax

Practice location:
  • Phone: 845-284-2321
  • Fax:
Mailing address:
  • Phone: 845-284-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: