Rupert, Jaclyn

Rupert, Jaclyn is an individual health care provider with primary practice located at 150 Pleasant Ave , Hamburg NY 14075-4828. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Rupert, Jaclyn can be contacted via phone (716) 430-5614.

Contact Information

Primary practice address
150 Pleasant Ave Hamburg NY 14075-4828
Phone: (716) 430-5614
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 004818-01

Profile Details

NPI number 1972871150
LBN Legal business name Rupert, Jaclyn
Credentials Certified Occupational Therapy Assistant (COTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 2nd, 2011
Last updated Dec 2nd, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972871150 NPPES
New York MEDICAID 166001780

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