Provider Demographics
NPI:1134310873
Name:DICKOW, JASON (OTR/L)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:DICKOW
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 COUNTRYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9579
Mailing Address - Country:US
Mailing Address - Phone:717-625-2772
Mailing Address - Fax:
Practice Address - Street 1:22 COUNTRYSIDE LN
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9579
Practice Address - Country:US
Practice Address - Phone:717-625-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005084L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist