Individual
JESSICA RAE DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
159 WEST FIRST STREET, OSWEGO, NY 13090
(315) 342-9575
Mailing address
4035 PLUM YEW CIR, LIVERPOOL, NY 13090-1117
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007595-1
NY
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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