Provider Demographics
NPI:1609063601
Name:ALIB, JEROME JAY (OTR)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:JAY
Last Name:ALIB
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 W INDUSTRIAL PARK DR STE 11
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2634
Mailing Address - Country:US
Mailing Address - Phone:812-332-7529
Mailing Address - Fax:
Practice Address - Street 1:2536 W INDUSTRIAL PARK DR STE 11
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2634
Practice Address - Country:US
Practice Address - Phone:812-332-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004511A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist