Provider Demographics
NPI:1558754119
Name:PELAEZ, JEANICE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JEANICE
Middle Name:
Last Name:PELAEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 COMMERCE STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598
Mailing Address - Country:US
Mailing Address - Phone:914-631-9020
Mailing Address - Fax:914-631-9028
Practice Address - Street 1:398 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009
Practice Address - Country:US
Practice Address - Phone:973-559-9096
Practice Address - Fax:973-239-5864
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09091700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant