Provider Demographics
NPI:1467605873
Name:GOW, JEANINE (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JEANINE
Middle Name:
Last Name:GOW
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 1:12C WATER WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1232
Mailing Address - Country:US
Mailing Address - Phone:845-728-9306
Mailing Address - Fax:
Practice Address - Street 1:873 ROUTE 45 STE 107
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1123
Practice Address - Country:US
Practice Address - Phone:845-362-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018316-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist