Provider Demographics
NPI:1417072562
Name:AUGUST, JEFF T (OTRL)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:T
Last Name:AUGUST
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 SKUNKNET RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632
Mailing Address - Country:US
Mailing Address - Phone:508-420-9190
Mailing Address - Fax:
Practice Address - Street 1:130 NORTH STREET
Practice Address - Street 2:CAPE COD HOSPITAL REHABILITATION
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-771-9600
Practice Address - Fax:508-775-1753
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist