Individual
BETH JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, MSOTR
Contact information
Practice address
219 COUNTY ROUTE 57, UNIT 20, PHOENIX, NY 13135-3300
(315) 934-4459
(315) 934-4459
Mailing address
219 COUNTY ROUTE 57, UNIT 20, PHOENIX, NY 13135-3300
(315) 934-4459
(315) 934-4459
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
015186
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03426868
—
NY
Enumeration date
12/16/2008
Last updated
03/29/2013
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