Healthcare Provider Details

I. General information

NPI: 1538569082
Provider Name (Legal Business Name): JAY TOOLE M.S. OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 SUGAR LN
PLAINFIELD IN
46168-8328
US

IV. Provider business mailing address

1450 ROBB HILL RD
MARTINSVILLE IN
46151-8900
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-7900
  • Fax:
Mailing address:
  • Phone: 310-990-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115756
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: