Healthcare Provider Details

I. General information

NPI: 1972852515
Provider Name (Legal Business Name): JENNIFER RUTH WHEELER MS, OTR / L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER RUTH LOUNSBURY MS, OTR / L

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELMWOOD AVE SUITE 100 (MARY CARIOLA CHILDRENS CENTER)
ROCHESTER NY
14620
US

IV. Provider business mailing address

1000 ELMWOOD AVE SUITE 100 (MARY CARIOLA CHILDRENS CENTER)
ROCHESTER NY
14620
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-0761
  • Fax:
Mailing address:
  • Phone: 315-657-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number017817
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number017817-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: