Provider Demographics
NPI:1578869210
Name:BECKER, JAIME R (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:R
Last Name:BECKER
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 CHESTERTON CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8305
Mailing Address - Country:US
Mailing Address - Phone:765-465-9284
Mailing Address - Fax:
Practice Address - Street 1:7242 WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-2273
Practice Address - Country:US
Practice Address - Phone:317-288-7606
Practice Address - Fax:317-288-7607
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004971A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist