Provider Demographics
NPI:1407161037
Name:ISAAC, JESSICA (COTA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 SIERRA VISTA LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-2717
Mailing Address - Country:US
Mailing Address - Phone:914-589-9209
Mailing Address - Fax:
Practice Address - Street 1:666 SIERRA VISTA LN
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-2717
Practice Address - Country:US
Practice Address - Phone:914-589-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005942-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant