Provider Demographics
NPI:1346284007
Name:DELOACH, JAMES D JR (OT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:DELOACH
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:DOUG
Other - Middle Name:
Other - Last Name:DELOACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:76359 AL HIGHWAY 77
Practice Address - Street 2:SUITE B
Practice Address - City:LINCOLN
Practice Address - State:AL
Practice Address - Zip Code:35096-5039
Practice Address - Country:US
Practice Address - Phone:630-296-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51526420OtherBCBS
AL51507914OtherBS
AL51509009OtherBS
AL51509034OtherBCBS
AL51509035OtherBCBS
AL51524965OtherBCBS
AL102I672857Medicare PIN
AL102G652859Medicare PIN
P83299Medicare UPIN