Provider Demographics
NPI:1003160656
Name:NOVAK, JAMIE M (OT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:NOVAK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:24400 HIGHPOINT RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6054
Mailing Address - Country:US
Mailing Address - Phone:216-896-0824
Mailing Address - Fax:216-896-0825
Practice Address - Street 1:24400 HIGHPOINT RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6054
Practice Address - Country:US
Practice Address - Phone:216-896-0824
Practice Address - Fax:216-896-0825
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist