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General NPI Number Information
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NPI Number | 1578798641
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Entity Type | Individual
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Provider Name | JENN-HOUNG YO OTR
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Gender | Male
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 2203 PEMBRIDGE LN
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City | JOLIET
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State | IL
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Zip | 60431-7731
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Country | US
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Telephone | 815-409-8301
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Fax |
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Provider Business Mailing Address
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Address Line | 410 ORLEANS AVE
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City | NAPERVILLE
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State | IL
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Zip | 60565-2634
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Country | US
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Telephone |
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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 | 056.007360
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License Number State | IL
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