Provider Demographics
NPI:1285197723
Name:FARLEY, JAMIE LEE (OTR)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 PALM ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2731
Mailing Address - Country:US
Mailing Address - Phone:269-598-1086
Mailing Address - Fax:269-665-4080
Practice Address - Street 1:1080 N 35TH ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-9761
Practice Address - Country:US
Practice Address - Phone:269-665-7043
Practice Address - Fax:269-665-4080
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist