Basic Information
| Provider Information | |||||||||
| NPI: | 1699198192 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | INGUTTI | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 LONG POND RD | ||||||||
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| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146121141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854899043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 FISHERS STATION DR | ||||||||
| Address2: | |||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145649744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2014 | ||||||||
| LastUpdateDate: | 08/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 115599 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XP0200X | 018643 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.