Provider Demographics
NPI:1659144020
Name:SCHALK, JORDAN KAY
Entity Type:Individual
Prefix:MISS
First Name:JORDAN
Middle Name:KAY
Last Name:SCHALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDY
Other - Middle Name:
Other - Last Name:SCHALK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:224 BOHICKET RD
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-7021
Mailing Address - Country:US
Mailing Address - Phone:317-503-7475
Mailing Address - Fax:
Practice Address - Street 1:801 POLE LINE RD W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5810
Practice Address - Country:US
Practice Address - Phone:208-814-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007867A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist