1467459826 NPI number — OCCUPATIONAL THERAPY SERVICES, INC.

Table of content: (NPI 1467459826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467459826 NPI number — OCCUPATIONAL THERAPY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCCUPATIONAL THERAPY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JUMP-IN PROFESSIONAL SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467459826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 205
Provider Second Line Business Mailing Address:
10400 HAMBURG RD
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48139-0205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-231-9042
Provider Business Mailing Address Fax Number:
810-231-9063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10400 HAMBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48139-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-231-9042
Provider Business Practice Location Address Fax Number:
810-231-9063
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KILBURN
Authorized Official First Name:
JACQUELIN
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-231-9042

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  L432774 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 67-0-D7-1058-0 . This is a "BCBS PROVIDER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4682580 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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