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NPI Code Detail

MEDICARE: JACQUELINE LORRAINE ELIASZEWSKYJ OT

MEDICARE: JACQUELINE LORRAINE ELIASZEWSKYJ OT
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
1225X00000XOccupational Therapist029826NY

General Provider Information

NPI Number : 1083820658
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE LORRAINE ELIASZEWSKYJ OT
Provider Business Mailing Address
First Line : 5790 BRISTOL CROSS RD
Second Line :
City : CANANDAIGUA
State : NY
Zip : 14424-8886
Country : US
Telephone Number : 206-819-4226
Fax Number :
Provider Business Practice Location Address
First Line : 439 W MAPLE AVE
Second Line :
City : NEWARK
State : NY
Zip : 14513-2062
Country : US
Telephone Number : 315-332-3328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 06/02/2026

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