Provider Demographics
NPI:1235375189
Name:BANNER, JESSICA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:BANNER
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 1:250 W 89TH ST
Mailing Address - Street 2:3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1700
Mailing Address - Country:US
Mailing Address - Phone:201-755-6620
Mailing Address - Fax:
Practice Address - Street 1:250 W 89TH ST
Practice Address - Street 2:3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1700
Practice Address - Country:US
Practice Address - Phone:201-755-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist