Provider Demographics
NPI:1124274550
Name:PIATAK, JESSICA LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:PIATAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:TEZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:840 BENMOSCHE ROAD
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742
Mailing Address - Country:US
Mailing Address - Phone:845-794-1400
Mailing Address - Fax:845-794-8909
Practice Address - Street 1:840 BENMOSCHE ROAD
Practice Address - Street 2:THE CENTER FOR DISCOVERY
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:845-794-8909
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008366225X00000X
NY010781-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist