Jacquelyn Johnson, OTR/L
Individual provider Active NPI Occupational Therapist · Princeton, IL
NPI 1710241286 · NPPES record last updated Jun 29, 2012
Key facts
- NPI
- 1710241286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 056.001008 (IL)
- Practice address
- 530 Park Ave E
Princeton, IL 61356-3901 - Phone
- (815) 876-4494
- Fax
- (815) 876-2030
- NPI assigned
- Jun 29, 2012
- 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 |
|---|---|---|---|
| 056.001008 | IL | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 056.001008 | IL | Yes |
Addresses
Primary practice location
530 Park Ave E
Princeton, IL 61356-3901
Mailing address
530 Park Ave E
Princeton, IL 61356-3901
Phone (815) 876-4494
Other providers in Princeton, IL
- Ihcc Hospice Inc
- Ihcc LLC
- Illinois Rural Community Care Organization
- Venkata C Jampala
- Jeffrey D Dzik OD & Associates LLC
- Lisa Johnson
- Journeys Counseling Assoc Inc
- Julia Rackley Perry Memorial Hospital
- Julia Rackley Perry Memorial Hospital
- Julia Rackley Perry Memorial Hospital
All providers in Princeton, IL · Occupational Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2012. 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.