Provider Demographics
NPI:1972150001
Name:KNOWLTON, JAYNE E (OTD)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:E
Last Name:KNOWLTON
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 IDESON RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-8604
Mailing Address - Country:US
Mailing Address - Phone:585-749-8386
Mailing Address - Fax:
Practice Address - Street 1:1081 IDESON RD
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-8604
Practice Address - Country:US
Practice Address - Phone:585-749-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004631225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist