Healthcare Provider Details

I. General information

NPI: 1881692853
Provider Name (Legal Business Name): ANTONIETA C JAUREGUI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 RYE RIDGE PLZ STE 107
RYE BROOK NY
10573-2828
US

IV. Provider business mailing address

10 RYE RIDGE PLZ STE 107
RYE BROOK NY
10573-2828
US

V. Phone/Fax

Practice location:
  • Phone: 914-305-9096
  • Fax: 914-305-4616
Mailing address:
  • Phone: 914-305-9096
  • Fax: 914-305-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0013171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: