MEDICARE: MRS. JANN JULIA DADIVAS OCAMPO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	012477	NY

General Provider Information

NPI Number	:	1588434914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANN JULIA DADIVAS OCAMPO PTA

Provider Business Mailing Address
First Line	:	10741 164TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2426
Country	:	US
Telephone Number	:	408-797-9649
Fax Number	:

Provider Business Practice Location Address
First Line	:	10741 164TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11433-2426
Country	:	US
Telephone Number	:	408-797-9649
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	01/05/2024

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