Provider Demographics
NPI:1841497930
Name:SEWARD, JEANNETTE L (OTR)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:L
Last Name:SEWARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JEANNETTE
Other - Middle Name:L
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:8423 SHEPARD RD
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166
Mailing Address - Country:US
Mailing Address - Phone:315-834-6265
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:MANDEL THERAPY GROUP
Practice Address - Street 2:8842 ROUTE 90
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-367-8016
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008521-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist