1164628103 NPI number — JACALYN M. PAPPAS O.T.

Table of content: JACALYN M. PAPPAS O.T. (NPI 1164628103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164628103 NPI number — JACALYN M. PAPPAS O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAPPAS
Provider First Name:
JACALYN
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WROBEL
Provider Other First Name:
JACALYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164628103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20372
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-0944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-785-1016
Provider Business Mailing Address Fax Number:
401-785-1018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1539 ATWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02919-3262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-351-0515
Provider Business Practice Location Address Fax Number:
401-351-0516
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT00681 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OT00681 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com