Provider Demographics
NPI:1164743977
Name:EIGES, JACLYN BETH (MED, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:BETH
Last Name:EIGES
Suffix:
Gender:F
Credentials:MED, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 VAN HOESEN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1723
Mailing Address - Country:US
Mailing Address - Phone:917-568-9323
Mailing Address - Fax:
Practice Address - Street 1:2050 VAN HOESEN AVE APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1723
Practice Address - Country:US
Practice Address - Phone:917-568-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014643225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics