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General NPI Number Information
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NPI Number | 1093229528
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Entity Type | Individual
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Provider Name | JESSICA ELAINE MARINACE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 167 ROUTE 304 STE 108
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City | BARDONIA
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State | NY
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Zip | 10954-2050
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Country | US
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Telephone | 845-337-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 69 MARTIN RD
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-5518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 018471
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License Number State | NY
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