Provider Demographics
NPI:1881967933
Name:HERBST, JESSICA ANNE (OTA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNE
Last Name:HERBST
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 BROOKLYN HEIGHTS RD
Mailing Address - Street 2:APT 1
Mailing Address - City:MILAN
Mailing Address - State:NY
Mailing Address - Zip Code:12571-4706
Mailing Address - Country:US
Mailing Address - Phone:845-656-8740
Mailing Address - Fax:
Practice Address - Street 1:2 BROOKLYN HEIGHTS RD
Practice Address - Street 2:APT 1
Practice Address - City:MILAN
Practice Address - State:NY
Practice Address - Zip Code:12571-4706
Practice Address - Country:US
Practice Address - Phone:845-656-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002844-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant