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General NPI Number Information
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NPI Number | 1194036285
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Entity Type | Individual
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Provider Name | JACLYN ROSE POMAJZL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 38777 6 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-2694
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Country | US
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Telephone | 888-414-7056
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Fax |
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Provider Business Mailing Address
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Address Line | 2610 WOODLAND AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-4616
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Country | US
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Telephone | 618-567-9656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201007749
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1218
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2003017242
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License Number State | MO
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