Provider Demographics
NPI:1467459826
Name:OCCUPATIONAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL THERAPY SERVICES, INC.
Other - Org Name:JUMP-IN PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELIN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KILBURN
Authorized Official - Suffix:II
Authorized Official - Credentials:MA, OTR
Authorized Official - Phone:810-231-9042
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:10400 HAMBURG RD
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139-0205
Mailing Address - Country:US
Mailing Address - Phone:810-231-9042
Mailing Address - Fax:810-231-9063
Practice Address - Street 1:10400 HAMBURG RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139-1204
Practice Address - Country:US
Practice Address - Phone:810-231-9042
Practice Address - Fax:810-231-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL432774174400000X
225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI67-0-D7-1058-0OtherBCBS PROVIDER
MI4682580Medicaid
MI67-0-D7-1058-0OtherBCBS PROVIDER