Provider Demographics
NPI:1013094572
Name:COBURN VAN HORN, JAMIE ANN (OT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:COBURN VAN HORN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:COBURN LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1550 OLD HENDERSON RD STE S-204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3626
Mailing Address - Country:US
Mailing Address - Phone:614-824-2633
Mailing Address - Fax:614-726-2399
Practice Address - Street 1:1550 OLD HENDERSON RD STE S-204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3626
Practice Address - Country:US
Practice Address - Phone:614-824-2633
Practice Address - Fax:614-467-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYOTR1641225X00000X
OHOT03999225X00000X
OHOT-003999225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty