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General NPI Number Information
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NPI Number | 1770848673
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Entity Type | Individual
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Provider Name | JESSICA SIENKIEWICZ PTA
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Gender | Female
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Dates
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Enumeration Date | 07/07/2012
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Last Update Date | 07/07/2012
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Provider Practice Location Address
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Address Line | 159 W 1ST ST
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City | OSWEGO
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State | NY
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Zip | 13126-2045
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Country | US
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Telephone | 315-342-9575
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Fax |
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Provider Business Mailing Address
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Address Line | 305 LYNN RD
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City | CAMILLUS
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State | NY
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Zip | 13031-1216
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Country | US
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Telephone | 315-487-3379
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 007006
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1130
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License Number State | CT
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