Provider Demographics
NPI:1427353366
Name:JONAS, BEVERLY D (MHS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:D
Last Name:JONAS
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 COUNTY ROUTE 125
Mailing Address - Street 2:GST BOCES ITINERANT AND RELATED SERVICES
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821-9518
Mailing Address - Country:US
Mailing Address - Phone:607-776-6788
Mailing Address - Fax:
Practice Address - Street 1:1 RAIDER LN
Practice Address - Street 2:SPECIAL EDUCATION DEPT.
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2344
Practice Address - Country:US
Practice Address - Phone:607-739-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005142-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist