Provider Demographics
NPI:1801117247
Name:RANARIO, JERRYMIAS HOMERES (OT)
Entity type:Individual
Prefix:
First Name:JERRYMIAS
Middle Name:HOMERES
Last Name:RANARIO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 8TH AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-3158
Mailing Address - Country:US
Mailing Address - Phone:917-286-5317
Mailing Address - Fax:917-286-5318
Practice Address - Street 1:3155 GRACE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3134
Practice Address - Country:US
Practice Address - Phone:718-435-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6535003225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics