Basic Information
| Provider Information | |||||||||
| NPI: | 1194273375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DYKES | ||||||||
| FirstName: | JAMI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4109 HIGHWAY 98 W | ||||||||
| Address2: | |||||||||
| City: | SUMMIT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396669132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012763900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 721 DUNAWAY LN | ||||||||
| Address2: | |||||||||
| City: | AZLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760202605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174442536 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2016 | ||||||||
| LastUpdateDate: | 12/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 3270 | MS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 215742 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.