Provider Demographics
NPI:1609116409
Name:IANDA, JENNIFER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:IANDA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4782 BOSTON POST RD
Mailing Address - Street 2:BLDG A, APT. 2D
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3047
Mailing Address - Country:US
Mailing Address - Phone:914-738-0320
Mailing Address - Fax:
Practice Address - Street 1:4782 BOSTON POST RD
Practice Address - Street 2:BLDG A, APT. 2D
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-3047
Practice Address - Country:US
Practice Address - Phone:914-738-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017828-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics