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General NPI Number Information
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NPI Number | 1710809884
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Entity Type | Individual
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Provider Name | JACOB JAMES WHITLOCK
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Gender | Male
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 101 S REID ST STE 201
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City | SIOUX FALLS
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State | SD
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Zip | 57103-7062
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Country | US
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Telephone | 605-335-3373
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Fax |
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Provider Business Mailing Address
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Address Line | 2918 E BISON TRL UNIT 7
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City | SIOUX FALLS
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State | SD
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Zip | 57108-8038
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Country | US
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Telephone | 605-520-4142
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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 | 556415
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License Number State | SD
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