Provider Demographics
NPI:1992997852
Name:JAKOSALEM, YVETTE LABAJO
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:LABAJO
Last Name:JAKOSALEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX A
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:MO
Mailing Address - Zip Code:65459-0166
Mailing Address - Country:US
Mailing Address - Phone:573-759-7149
Mailing Address - Fax:573-759-2952
Practice Address - Street 1:106 W FOURTH ST
Practice Address - Street 2:DIXON REORGAIZED DISTR R-1
Practice Address - City:DIXON
Practice Address - State:MO
Practice Address - Zip Code:65459-0166
Practice Address - Country:US
Practice Address - Phone:573-759-7149
Practice Address - Fax:573-759-2952
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005032412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist