Provider Demographics
NPI:1811039696
Name:MELETIOU, JESSICA J (OT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:J
Last Name:MELETIOU
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27401 W IL ROUTE 22
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5999
Mailing Address - Country:US
Mailing Address - Phone:847-381-8812
Mailing Address - Fax:847-381-6311
Practice Address - Street 1:27401 W IL ROUTE 22
Practice Address - Street 2:SUITE 107
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5999
Practice Address - Country:US
Practice Address - Phone:847-381-8812
Practice Address - Fax:847-381-6311
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22404Medicare ID - Type UnspecifiedTHERAPIST NUMBER