Healthcare Provider Details

I. General information

NPI: 1710809884
Provider Name (Legal Business Name): JACOB JAMES WHITLOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S REID ST STE 201
SIOUX FALLS SD
57103-7062
US

IV. Provider business mailing address

2918 E BISON TRL UNIT 7
SIOUX FALLS SD
57108-8038
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-3373
  • Fax:
Mailing address:
  • Phone: 605-520-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number556415
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: