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NPI Code Detail

MEDICARE: MS. JACKELYN SHEREE JONES OTR

MEDICARE: MS. JACKELYN SHEREE JONES OTR
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 Therapist056012321IL

General Provider Information

NPI Number : 1609331966
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACKELYN SHEREE JONES OTR
Provider Business Mailing Address
First Line : 3420 WESTERN AVE
Second Line :
City : PARK FOREST
State : IL
Zip : 60466-1839
Country : US
Telephone Number : 708-752-6595
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S DREXEL BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4301
Country : US
Telephone Number : 773-285-0550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2019
Last Update Date : 01/31/2019

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