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General NPI Number Information
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NPI Number | 1417257205
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Entity Type | Individual
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Provider Name | JENNIFER TRACY VALANDRA MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 43 HERITAGE DR APT E
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City | NEW CITY
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State | NY
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Zip | 10956-5325
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Country | US
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Telephone | 914-262-1676
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Fax |
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Provider Business Mailing Address
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Address Line | 43E HERITAGE DRIVE
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City | NEW CITY
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State | NY
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Zip | 10956
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Country | US
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Telephone | 914-262-1676
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 016383-1
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License Number State | NY
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