Provider Demographics
NPI:1770120438
Name:ELLIOTT, JEFFREY (OTR, CHT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
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 1:11761 LOWER DR
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3676
Mailing Address - Country:US
Mailing Address - Phone:607-857-0885
Mailing Address - Fax:
Practice Address - Street 1:9768 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9094
Practice Address - Country:US
Practice Address - Phone:607-937-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8794225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand