Provider Demographics
NPI:1467605386
Name:OLAY, JESUS (OTR)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:OLAY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRUSCHI LANE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877
Mailing Address - Country:US
Mailing Address - Phone:917-974-2748
Mailing Address - Fax:
Practice Address - Street 1:3 GREENHILLS ROAD
Practice Address - Street 2:UP WEE GROW, INC.
Practice Address - City:SOUTH HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:516-777-8777
Practice Address - Fax:516-777-3293
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010052-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist