Provider Demographics
NPI:1194913202
Name:ABRAHAM, JAYNE R (OT)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:R
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:R
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:312 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1888
Practice Address - Country:US
Practice Address - Phone:641-844-2294
Practice Address - Fax:641-844-2297
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist