National Provider Identifier
Jennifer Ann Fackelman, OTR
Jennifer Ann Fackelman, OTR is listed in the NPPES registry with a primary specialty of Pediatric Occupational Therapist in Fairport, NY and a listed phone number of (585) 797-9366.
Profile Overview
- NPI
- 1861630972
- Provider Type
- Individual
- Primary Specialty
- Pediatric Occupational Therapist
- Enumeration Date
- January 27, 2009
- Last Updated
- January 27, 2009
Practice Location
- 42 Norbrook RD
- Fairport, NY 14450-8958
Phone: (585) 797-9366
Specialties
- Pediatric Occupational Therapist (225XP0200X)
Full Record
- NPI
- 1861630972
- Entity Type
- Individual
- Last Name
- Fackelman
- First Name
- Jennifer
- Middle Name
- Ann
- Name Prefix
- Mrs.
- Credential
- OTR
- Provider Other Last Name
- Burnisky
- Provider Other First Name
- Jennifer
- Provider Other Middle Name
- Ann
- Provider Other Name Prefix Text
- Miss
- Provider Other Credential Text
- OTR
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 42 Norbrook RD
- Mailing City
- Fairport
- Mailing State
- NY
- Mailing ZIP Code
- 14450-8958
- Mailing Country
- US
- Mailing Phone
- (585) 797-9366
- Mailing Fax
- (585) 486-1230
- Practice Street Address
- 42 Norbrook RD
- Practice City
- Fairport
- Practice State
- NY
- Practice ZIP Code
- 14450-8958
- Practice Country
- US
- Practice Phone
- (585) 797-9366
- Practice Fax
- (585) 486-1230
- Enumeration Date
- January 27, 2009
- Last Updated
- January 27, 2009
- Sex
- Female
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Pediatric Occupational Therapist (225XP0200X)