Provider Demographics
NPI:1649490780
Name:SERRA, JAMIE L (OTR,CHT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:SERRA
Suffix:
Gender:F
Credentials:OTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 ROUTE 300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1757
Mailing Address - Country:US
Mailing Address - Phone:914-805-1673
Mailing Address - Fax:845-562-0553
Practice Address - Street 1:1634 ROUTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1757
Practice Address - Country:US
Practice Address - Phone:914-805-1673
Practice Address - Fax:845-562-0553
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004003225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics