Basic Information
| Provider Information | |||||||||
| NPI: | 1689827875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IGLTHALER | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 EAGLESHEAD RD | ||||||||
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| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148509659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075396708 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1695 GLEN ALLEN ROAD | ||||||||
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| City: | OWEGO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077257420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2008 | ||||||||
| LastUpdateDate: | 10/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 013061 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.