Basic Information
| Provider Information | |||||||||
| NPI: | 1558691717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERECEK | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 170 TAYLOR STATION RD | ||||||||
| Address2: | HAND CLINIC | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145457930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 TAYLOR STATION RD | ||||||||
| Address2: | HAND CLINIC | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432134441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145457930 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2010 | ||||||||
| LastUpdateDate: | 01/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 6222 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.