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General NPI Number Information
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NPI Number | 1679926034
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Entity Type | Individual
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Provider Name | JARED SHANE ROMINES OTR/L
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Gender | Male
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 1921 STONECIPHER DR
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City | ADA
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State | OK
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Zip | 74820-3439
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Country | US
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Telephone | 580-272-5555
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Fax | 580-421-6217
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Provider Business Mailing Address
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Address Line | 1921 STONECIPHER DR
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City | ADA
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State | OK
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Zip | 74820-3439
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Country | US
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Telephone |
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Fax | 580-421-6217
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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 | 2042
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License Number State | OK
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