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NPI Code Detail

MEDICARE: JESSIE CORTLANDT PARKULO OTR/L

MEDICARE: JESSIE CORTLANDT PARKULO OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist
2225X00000XOccupational Therapist31006414AIN

General Provider Information

NPI Number : 1306362272
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSIE CORTLANDT PARKULO OTR/L
Provider Business Mailing Address
First Line : 1718 EMERALD PINES LN
Second Line :
City : WESTFIELD
State : IN
Zip : 46074-9147
Country : US
Telephone Number : 304-312-7867
Fax Number :
Provider Business Practice Location Address
First Line : 7507 MICHIGAN RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-2321
Country : US
Telephone Number : 304-312-7867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2017
Last Update Date : 04/30/2021

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