Healthcare Provider Details

I. General information

NPI: 1811192602
Provider Name (Legal Business Name): CARRIE MARIE JONES OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 W HIGGINS RD
HOFFMAN ESTATES IL
60195-2413
US

IV. Provider business mailing address

2371 STANTON CIR
LAKE IN THE HILLS IL
60156-6240
US

V. Phone/Fax

Practice location:
  • Phone: 847-519-0300
  • Fax:
Mailing address:
  • Phone: 847-669-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: