Provider Demographics
NPI:1164704318
Name:DORRITIE, JESSICA JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:DORRITIE
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 1:162 COUNTY HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:MOUNT VISION
Mailing Address - State:NY
Mailing Address - Zip Code:13810-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 JUMP BROOK ROAD
Practice Address - Street 2:
Practice Address - City:GRAND GORGE
Practice Address - State:NY
Practice Address - Zip Code:12434-2801
Practice Address - Country:US
Practice Address - Phone:607-588-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015450-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist