Healthcare Provider Details

I. General information

NPI: 1831667765
Provider Name (Legal Business Name): UNNATI JAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 W TURTLE CREEK DR
SOUTH BEND IN
46637-5660
US

IV. Provider business mailing address

1639 W TURTLE CREEK DR
SOUTH BEND IN
46637-5660
US

V. Phone/Fax

Practice location:
  • Phone: 213-431-7608
  • Fax:
Mailing address:
  • Phone: 213-431-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31006786A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: