Provider Demographics
NPI:1821519935
Name:FERENCE, JODY GAIL (OTR/L)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:GAIL
Last Name:FERENCE
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 1:55 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9757
Mailing Address - Country:US
Mailing Address - Phone:518-330-9636
Mailing Address - Fax:
Practice Address - Street 1:700 DELAWARE AVE.
Practice Address - Street 2:BETHLEHEM CENTRAL SCHOOL DISTRICT
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-439-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0196991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist