Provider Demographics
NPI:1215384599
Name:SANTOS, JAYCEE
Entity Type:Individual
Prefix:
First Name:JAYCEE
Middle Name:
Last Name:SANTOS
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 1:9703 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:BACONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31716-7834
Mailing Address - Country:US
Mailing Address - Phone:229-376-0659
Mailing Address - Fax:
Practice Address - Street 1:9703 LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:BACONTON
Practice Address - State:GA
Practice Address - Zip Code:31716-7834
Practice Address - Country:US
Practice Address - Phone:229-376-0659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002039224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant