Provider Demographics
NPI:1912228164
Name:BARBUTI VAN LEUKEN, JILL CHARLENE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHARLENE
Last Name:BARBUTI VAN LEUKEN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CHARLENE BARBUTI
Other - Last Name:VAN LEUKEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:313 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5225
Mailing Address - Country:US
Mailing Address - Phone:607-351-1797
Mailing Address - Fax:
Practice Address - Street 1:313 CENTER ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5225
Practice Address - Country:US
Practice Address - Phone:607-351-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014620-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist