Provider Demographics
NPI:1306505581
Name:WOOTAN, JARED (OTR/L)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WOOTAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 JOY PL
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2439
Mailing Address - Country:US
Mailing Address - Phone:917-608-8545
Mailing Address - Fax:
Practice Address - Street 1:13 JOY PL
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2439
Practice Address - Country:US
Practice Address - Phone:917-608-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty