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General NPI Number Information
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NPI Number | 1639349483
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Entity Type | Individual
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Provider Name | JINO JACOB OT
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Gender | Male
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 259 E ERIE ST STE 13-205
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City | CHICAGO
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State | IL
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Zip | 60611-2987
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Country | US
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Telephone | 312-695-8143
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Fax | 312-472-4889
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Provider Business Mailing Address
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Address Line | 259 E ERIE ST STE 13-205
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City | CHICAGO
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State | IL
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Zip | 60611-2987
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Country | US
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Telephone | 312-695-8143
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Fax | 312-472-4889
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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 | 056006527
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License Number State | IL
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