Provider Demographics
NPI:1164650909
Name:PADMORE, JACKIE A (OTR/L)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:A
Last Name:PADMORE
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 1:61 W GRAND ST
Mailing Address - Street 2:OC
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2133
Mailing Address - Country:US
Mailing Address - Phone:914-664-9558
Mailing Address - Fax:866-352-6711
Practice Address - Street 1:61 W GRAND ST
Practice Address - Street 2:OC
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2133
Practice Address - Country:US
Practice Address - Phone:914-664-9558
Practice Address - Fax:866-352-6711
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010811-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist