Healthcare Provider Details

I. General information

NPI: 1356754394
Provider Name (Legal Business Name): JESSICA HUANG OTD, OTD/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 10/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FAIRFIELD ST
STATEN ISLAND NY
10308-1823
US

IV. Provider business mailing address

15 FAIRFIELD ST
STATEN ISLAND NY
10308-1823
US

V. Phone/Fax

Practice location:
  • Phone: 917-992-9735
  • Fax:
Mailing address:
  • Phone: 917-992-9735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number018863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: