Provider Demographics
NPI:1396227567
Name:FORD, JAMA LYN
Entity Type:Individual
Prefix:MRS
First Name:JAMA
Middle Name:LYN
Last Name:FORD
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 1:4792 MASONS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8425
Mailing Address - Country:US
Mailing Address - Phone:765-412-2797
Mailing Address - Fax:
Practice Address - Street 1:4792 MASONS RIDGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8425
Practice Address - Country:US
Practice Address - Phone:765-412-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist