Provider Demographics
NPI:1083324792
Name:JULIAN, JENINE CATHERINE SANTOS (MA, OTR/L, OTRP)
Entity Type:Individual
Prefix:MS
First Name:JENINE CATHERINE
Middle Name:SANTOS
Last Name:JULIAN
Suffix:
Gender:F
Credentials:MA, OTR/L, OTRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MARIPOSA DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6735
Mailing Address - Country:US
Mailing Address - Phone:315-806-9404
Mailing Address - Fax:
Practice Address - Street 1:675 3RD AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5731
Practice Address - Country:US
Practice Address - Phone:212-922-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist