Healthcare Provider Details

I. General information

NPI: 1447563242
Provider Name (Legal Business Name): JESSICA KLEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 STAFFORD AVE
STATEN ISLAND NY
10309-2109
US

IV. Provider business mailing address

211 W 10TH ST APT 6A
NEW YORK NY
10014-2987
US

V. Phone/Fax

Practice location:
  • Phone: 303-331-9963
  • Fax:
Mailing address:
  • Phone: 303-656-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number016416
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1598
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: