Provider Demographics
NPI:1801249131
Name:HROMADA, JESSICA ASHLEY (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ASHLEY
Last Name:HROMADA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2312
Mailing Address - Country:US
Mailing Address - Phone:516-425-8571
Mailing Address - Fax:
Practice Address - Street 1:12 LINDA LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2312
Practice Address - Country:US
Practice Address - Phone:516-425-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020756-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist