Provider Demographics
NPI:1245588482
Name:FARRY, JESSICA LEE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:FARRY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 DELAWARE AVENUE
Mailing Address - Street 2:THE MCGUIRE GROUP
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-0000
Mailing Address - Country:US
Mailing Address - Phone:716-819-1545
Mailing Address - Fax:
Practice Address - Street 1:560 DELAWARE AVENUE
Practice Address - Street 2:THE MCGUIRE GROUP
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-0000
Practice Address - Country:US
Practice Address - Phone:716-819-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016305-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist