Provider Demographics
NPI:1740427566
Name:DUSENBERY, JACLYN CARA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:CARA
Last Name:DUSENBERY
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 1:2452 KRAFT RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9536
Mailing Address - Country:US
Mailing Address - Phone:518-506-9885
Mailing Address - Fax:518-479-0208
Practice Address - Street 1:2452 KRAFT RD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9536
Practice Address - Country:US
Practice Address - Phone:518-506-9885
Practice Address - Fax:518-479-0208
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012160-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist