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General NPI Number Information
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NPI Number | 1336698067
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Entity Type | Individual
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Provider Name | JADE NICOLE VERGE MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 105 E RAY FINE BLVD STE L
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City | ROLAND
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State | OK
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Zip | 74954-5331
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Country | US
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Telephone | 918-675-0075
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Fax | 918-675-0801
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Provider Business Mailing Address
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Address Line | 2 OLD GREENWOOD LN
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City | FORT SMITH
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State | AR
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Zip | 72903-6411
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Country | US
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Telephone | 479-459-0636
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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 | OTR2964
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License Number State | AR
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