Basic Information
| Provider Information | |||||||||
| NPI: | 1366911257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PULLIAM | ||||||||
| FirstName: | JARED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 WATTEN LN | ||||||||
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| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430813777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143127087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 542 16TH ST | ||||||||
| Address2: | |||||||||
| City: | RAWLINS | ||||||||
| State: | WY | ||||||||
| PostalCode: | 823015241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073242759 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2018 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XG0600X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | 225X00000X | OT-1425 | WY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.