Provider Demographics
NPI:1558691717
Name:BERECEK, JAIME LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN
Last Name:BERECEK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 TAYLOR STATION RD
Mailing Address - Street 2:HAND CLINIC
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4441
Mailing Address - Country:US
Mailing Address - Phone:614-545-7930
Mailing Address - Fax:
Practice Address - Street 1:170 TAYLOR STATION RD
Practice Address - Street 2:HAND CLINIC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4441
Practice Address - Country:US
Practice Address - Phone:614-545-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6222225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand