Provider Demographics
NPI:1518676113
Name:DISTANCE THERAPIES OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:DISTANCE THERAPIES OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:518-209-9648
Mailing Address - Street 1:82 SOUTHBURY RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-7709
Mailing Address - Country:US
Mailing Address - Phone:518-209-9648
Mailing Address - Fax:
Practice Address - Street 1:800 ROUTE 146 BLDG 400 SUITE 494
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:182-099-6485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISTANCE THERAPIES OCCUPATIONAL THERAPY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency