Provider Demographics
NPI:1063986693
Name:JAKOVAC, LANI (OTRL)
Entity type:Individual
Prefix:
First Name:LANI
Middle Name:
Last Name:JAKOVAC
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31893 TOVENIA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-8756
Mailing Address - Country:US
Mailing Address - Phone:313-917-8396
Mailing Address - Fax:
Practice Address - Street 1:13500 PINE ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4613
Practice Address - Country:US
Practice Address - Phone:734-946-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000132225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics