Provider Demographics
NPI:1003228370
Name:GILLETTE, JAMIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:RICICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3176 CHELTENHAM RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 PAGE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1430
Practice Address - Country:US
Practice Address - Phone:419-865-7487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.4705224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant