Provider Demographics
NPI:1912109026
Name:BERTRAND, JASON GEORGE (OTR)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:GEORGE
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CHAMPLAIN ROAD
Mailing Address - Street 2:P.O. BOX 220
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170
Mailing Address - Country:US
Mailing Address - Phone:203-619-2691
Mailing Address - Fax:
Practice Address - Street 1:17 CHIPMAN WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1039
Practice Address - Country:US
Practice Address - Phone:781-336-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8212225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist