Provider Demographics
NPI:1043789894
Name:VAN BLARCOM, JAMIE RENAE (OTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:RENAE
Last Name:VAN BLARCOM
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20560 BINNEY ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20560 BINNEY ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-2092
Practice Address - Country:US
Practice Address - Phone:402-321-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA509224Z00000X
NE324224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant