MEDICARE: JACKLYN MARIE IANNITTI OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	020007	NY

General Provider Information

NPI Number	:	1043672595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYN MARIE IANNITTI OTR/L

Provider Business Mailing Address
First Line	:	21343 35TH AVE
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2372
Country	:	US
Telephone Number	:	917-574-5415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 BELL BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11361-2375
Country	:	US
Telephone Number	:	917-574-5415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	01/14/2026

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