Provider Demographics
NPI:1871593087
Name:VANVALKENBURG, JESSICA L (OT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:VANVALKENBURG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:LOUNSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:66 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10537-1309
Mailing Address - Country:US
Mailing Address - Phone:845-284-2321
Mailing Address - Fax:
Practice Address - Street 1:66 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:LAKE PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10537-1309
Practice Address - Country:US
Practice Address - Phone:845-284-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics