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General NPI Number Information
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NPI Number | 1205448602
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Entity Type | Individual
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Provider Name | JESSICA CLARA BANSCHBACH
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Gender | Female
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 869 WINTHROP DR
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City | EAST MEADOW
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State | NY
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Zip | 11554-4629
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Country | US
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Telephone | 516-640-8422
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Fax |
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Provider Business Mailing Address
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Address Line | 869 WINTHROP DR
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City | EAST MEADOW
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State | NY
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Zip | 11554-4629
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Country | US
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Telephone | 516-640-8422
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 025035
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License Number State | NY
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