Provider Demographics
NPI:1851120455
Name:GOLDMAN, JESSICA LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:GOLDMAN
Suffix:
Gender:F
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 1:84 MONROE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6516
Mailing Address - Country:US
Mailing Address - Phone:914-980-7269
Mailing Address - Fax:
Practice Address - Street 1:577 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4383
Practice Address - Country:US
Practice Address - Phone:212-254-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029292225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics