Provider Demographics
NPI:1750940813
Name:FERRER, JAQUELINE (COTA/L)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:FERRER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E PIERREPONT AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2417
Mailing Address - Country:US
Mailing Address - Phone:201-362-0462
Mailing Address - Fax:
Practice Address - Street 1:1594 TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5904
Practice Address - Country:US
Practice Address - Phone:718-299-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09584-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant