Provider Demographics
NPI:1376895003
Name:CONNIFF, JENNIFER LYNN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:CONNIFF
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 1:111 W NOYES BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:NY
Mailing Address - Zip Code:13461-1132
Mailing Address - Country:US
Mailing Address - Phone:315-363-8288
Mailing Address - Fax:
Practice Address - Street 1:111 W NOYES BLVD
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1132
Practice Address - Country:US
Practice Address - Phone:315-363-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017040-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00316789Medicaid
NY335546Medicare PIN