Provider Demographics
NPI:1811256753
Name:LAZARUS, JESSICA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LAZARUS
Suffix:
Gender:F
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 1:1470 W TERRACE CIR
Mailing Address - Street 2:APT 2
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5227
Mailing Address - Country:US
Mailing Address - Phone:914-953-2635
Mailing Address - Fax:
Practice Address - Street 1:1470 W TERRACE CIR
Practice Address - Street 2:APT 2
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5227
Practice Address - Country:US
Practice Address - Phone:914-953-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00702300225X00000X
NY017324225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist