Provider Demographics
NPI:1760990816
Name:MAYERHOFF, JESSICA (MSOT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MAYERHOFF
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14448 72ND RD APT 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2406
Mailing Address - Country:US
Mailing Address - Phone:954-829-0032
Mailing Address - Fax:
Practice Address - Street 1:14737 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1719
Practice Address - Country:US
Practice Address - Phone:954-829-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022097-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty