Provider Demographics
NPI:1184112930
Name:BILLUPS, JORDAN KAY (OTA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:KAY
Last Name:BILLUPS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:DOUDS
Mailing Address - State:IA
Mailing Address - Zip Code:52551-8206
Mailing Address - Country:US
Mailing Address - Phone:641-919-2112
Mailing Address - Fax:
Practice Address - Street 1:10 VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2059
Practice Address - Country:US
Practice Address - Phone:319-524-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant