Provider Demographics
NPI:1629351184
Name:JAGOW, REBECCA ALICE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ALICE
Last Name:JAGOW
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 1:67 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4231
Mailing Address - Country:US
Mailing Address - Phone:716-677-6607
Mailing Address - Fax:
Practice Address - Street 1:67 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4231
Practice Address - Country:US
Practice Address - Phone:716-677-6607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006205-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist