Basic Information
| Provider Information | |||||||||
| NPI: | 1730699166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICKS | ||||||||
| FirstName: | JAROM | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7997 NW 90TH AVE | ||||||||
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| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344821910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617033629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16690 SW CHIPOLA RD | ||||||||
| Address2: | |||||||||
| City: | BLOUNTSTOWN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324241953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506744311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2017 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT18715 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.