Provider Demographics
NPI:1417257205
Name:VALANDRA, JENNIFER TRACY (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TRACY
Last Name:VALANDRA
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 1:43E HERITAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:914-262-1676
Mailing Address - Fax:
Practice Address - Street 1:43 HERITAGE DR APT E
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5325
Practice Address - Country:US
Practice Address - Phone:914-262-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016383-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist