Provider Demographics
NPI:1073896882
Name:PERKINS, JACLYN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:TUCCIARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:555 SAINT JOSEPHS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3223
Mailing Address - Country:US
Mailing Address - Phone:607-733-6541
Mailing Address - Fax:
Practice Address - Street 1:555 SAINT JOSEPHS BLVD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3223
Practice Address - Country:US
Practice Address - Phone:607-733-6541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016866-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist