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NPI Code Detail

MEDICARE: JENNIFER ANN KONDOLF-DUBA OTR/L

MEDICARE: JENNIFER ANN KONDOLF-DUBA 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
1225XP0200XPediatric Occupational Therapist002008-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609158823
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN KONDOLF-DUBA OTR/L
Provider Business Mailing Address
First Line : 5910 JONES RD
Second Line :
City : CANANDAIGUA
State : NY
Zip : 14424-8924
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 96 W GIBSON ST
Second Line :
City : CANANDAIGUA
State : NY
Zip : 14424-1453
Country : US
Telephone Number : 585-396-3930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2011
Last Update Date : 09/14/2011

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