Provider Demographics
NPI:1255460291
Name:SPICER, JESSICA L (OTR L)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:SPICER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:MORUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2669 DUNBAR WOODS RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-9703
Mailing Address - Country:US
Mailing Address - Phone:315-472-4404
Mailing Address - Fax:
Practice Address - Street 1:800 S WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2732
Practice Address - Country:US
Practice Address - Phone:315-472-4404
Practice Address - Fax:315-478-2337
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005916-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist