Provider Demographics
NPI:1396084372
Name:NIBLOCK, JAYNA (PHD, OTD, OTR/L, BCP)
Entity type:Individual
Prefix:DR
First Name:JAYNA
Middle Name:
Last Name:NIBLOCK
Suffix:
Gender:F
Credentials:PHD, OTD, OTR/L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6182 S JACKSON GAP CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2797
Mailing Address - Country:US
Mailing Address - Phone:712-790-0250
Mailing Address - Fax:
Practice Address - Street 1:6911 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1426
Practice Address - Country:US
Practice Address - Phone:303-221-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077800225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics