Jordan Samuel Lowry
Individual provider Active NPI Occupational Therapy Assistant · Moro, IL
NPI 1932868080 · NPPES record last updated Dec 15, 2021
Key facts
- NPI
- 1932868080
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 057005672 (IL)
- Practice address
- 6330 High St
Moro, IL 62067-1416 - Phone
- (618) 960-5080
- NPI assigned
- Dec 15, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 057005672 | IL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 057005672 | IL | Yes |
Addresses
Primary practice location
6330 High St
Moro, IL 62067-1416
Mailing address
6330 High St
Moro, IL 62067-1416
Phone (618) 960-5080
Other providers in Moro, IL
All providers in Moro, IL · Occupational Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2021. 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.