Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 003088-1 | NY |
N | 225XE0001X | Environmental Modification | 003088-1 | NY |
N | 225XF0002X | Feeding, Eating & Swallowing | 003088-1 | NY |
N | 225XG0600X | Occupational Therapist - Gerontology | 003088-1 | NY |
N | 225XH1200X | Occupational Therapist - Hand | 03088-1 | NY |
N | 225XL0004X | Low Vision | 003088-1 | NY |
N | 225XM0800X | Mental Health | 003088-1 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 003088-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 003088-1 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 003088-1 | NY |
NPI | 1134361637 |
---|---|
Provider Name | Ms. Maureen Bernier Jakubson |
First Address | Ithaca, NY 14850-9459 |
Second Address | Ithaca, NY 14850-9459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 30/03/2009 |