MEDICARE: JABBERGYM, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	2251P0200X	Pediatric Physical Therapist
3	225200000X	Physical Therapy Assistant
4	225XP0200X	Pediatric Occupational Therapist
5	2355S0801X	Speech-Language Assistant
6	252Y00000X	Early Intervention Provider Agency
7	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1861623175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JABBERGYM, INC.

Provider Business Mailing Address
First Line	:	151 N SUNRISE AVE
Second Line	:	SUITE 1105
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2924
Country	:	US
Telephone Number	:	916-771-8255
Fax Number	:	916-771-8211

Provider Business Practice Location Address
First Line	:	151 N SUNRISE AVE
Second Line	:	SUITE 1105
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2924
Country	:	US
Telephone Number	:	916-771-8255
Fax Number	:	916-771-8211

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DAYNA R THOMAS
Credential	:	M.S. CCC-SLP
Telephone Number	:	916-390-9699

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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Directions to “JABBERGYM, INC. ” Practice Location

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