Carolyn Marie Jane

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.002558 Issued in IL

Practice address

3775 Grand Ave
Gurnee, IL 60031-2909

Phone

(847) 623-6300

NPI assigned

Jun 26, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1629563283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14500 TOWNE TRAIL",
            "city": "GREEN OAKS",
            "state": "IL",
            "postal_code": "60048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 GRAND AVE",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312909",
            "telephone_number": "847-623-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Pembridge Dr",
            "address_purpose": "LOCATION",
            "city": "Lake Forest",
            "state": "IL",
            "postal_code": "600454222",
            "country_code": "US",
            "telephone_number": "800-886-8409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JANE",
        "first_name": "CAROLYN",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-26",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.002558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Marie Jackson, MSW, LSW, CDP
• Justin S Jacob, PHARMD
• Charles E Jaffe, DO
• Peter Eriq Jaffe
• Donville A James
• Cindy Louise Jarosch, PTA
• JBS Wellness, LLC.
• Jean Vargas & Associates, LTD.
• Jeffrey J Hicks DPM PC
• Carol L Jeffries, DMD

• Occupational Therapist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.