Provider Demographics
NPI:1013793025
Name:GUZMAN, JESSICA MARILYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARILYN
Last Name:GUZMAN
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 1:554 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1706
Mailing Address - Country:US
Mailing Address - Phone:917-375-3185
Mailing Address - Fax:
Practice Address - Street 1:554 ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1706
Practice Address - Country:US
Practice Address - Phone:917-375-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics