Provider Demographics
NPI:1093148645
Name:MERRY, JAYMIE M (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAYMIE
Middle Name:M
Last Name:MERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COTTAGE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8654
Mailing Address - Country:US
Mailing Address - Phone:585-797-9366
Mailing Address - Fax:
Practice Address - Street 1:952 LITTLE BARDFIELD RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8803
Practice Address - Country:US
Practice Address - Phone:585-355-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018169225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics