Provider Demographics
NPI:1366789398
Name:ULKLOSS, JEAN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:ULKLOSS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 ARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4442
Mailing Address - Country:US
Mailing Address - Phone:267-980-1742
Mailing Address - Fax:
Practice Address - Street 1:1940 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4442
Practice Address - Country:US
Practice Address - Phone:267-980-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012128225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist