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General NPI Number Information
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NPI Number | 1053758763
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Entity Type | Organization
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Legal Business Name | JJA THERAPIES INC
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 500 W SUPERIOR ST #2204
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City | CHICAGO
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State | IL
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Zip | 60654-8132
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Country | US
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Telephone | 773-738-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W SUPERIOR ST #2204
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City | CHICAGO
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State | IL
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Zip | 60654-8132
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Country | US
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Telephone | 773-738-6365
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JACQUELINE B JENSEN
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Credential | OTR/L
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Telephone | 773-738-6365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056.007801
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License Number State | IL
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