Provider Demographics
NPI:1750557922
Name:CALCARA, JASON VINCENT (MS, OTR/L)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:VINCENT
Last Name:CALCARA
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9556 BANTRY LN
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9544
Mailing Address - Country:US
Mailing Address - Phone:315-668-2497
Mailing Address - Fax:
Practice Address - Street 1:9556 BANTRY LN
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-9544
Practice Address - Country:US
Practice Address - Phone:315-668-2497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015216225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist