Provider Demographics
NPI:1710456009
Name:NEGRE, JOLAN
Entity Type:Individual
Prefix:
First Name:JOLAN
Middle Name:
Last Name:NEGRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 VALLEY LAKE DR APT 1065
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3640
Mailing Address - Country:US
Mailing Address - Phone:217-819-2257
Mailing Address - Fax:
Practice Address - Street 1:1427 VALLEY LAKE DR APT 1065
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3640
Practice Address - Country:US
Practice Address - Phone:217-819-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty