Individual
JESSICA LYNN GANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
502 WALNUT ST, ROME, NY 13440-2638
(315) 281-3960
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
007091
NY
224Z00000X
Occupational Therapy Assistant
Primary
007091-01
NY
Other
Enumeration date
03/20/2009
Last updated
09/15/2020
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