Jennifer Bliss, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · Saybrook, IL
NPI 1417366451 · NPPES record last updated Aug 4, 2014
Key facts
- NPI
- 1417366451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057.003147 (IL)
- Practice address
- 201 E Jackson St
Saybrook, IL 61770-9497 - Phone
- (217) 714-8886
- NPI assigned
- Aug 4, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 057.003147 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057.003147 | IL | Yes |
Addresses
Primary practice location
201 E Jackson St
Saybrook, IL 61770-9497
Mailing address
201 E Jackson St
Saybrook, IL 61770-9497
Other names
- Jennifer Beck
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.