Provider Demographics
NPI:1992403372
Name:WHEELER, JODI KATHLEEN (OT)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:KATHLEEN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:NY
Mailing Address - Zip Code:13407-1119
Mailing Address - Country:US
Mailing Address - Phone:315-360-4655
Mailing Address - Fax:
Practice Address - Street 1:2640 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SAUQUOIT
Practice Address - State:NY
Practice Address - Zip Code:13456-3220
Practice Address - Country:US
Practice Address - Phone:315-839-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027596-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist