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Individual

JACKIE KATHLEEN PROFERA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
43 NEW SCOTLAND AVE, ALBANY, NY 12208-3412
(518) 262-3291
(518) 262-4492
Mailing address
43 NEW SCOTLAND AVE, ALBANY, NY 12208-3478
(518) 262-4492

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
009663-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
009663-1
NYS
NY
Enumeration date
01/09/2019
Last updated
01/09/2019
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