Provider Demographics
NPI:1396084745
Name:SUBRAMANIAN, JAYANTHI (OT)
Entity type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:
Last Name:SUBRAMANIAN
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 1:18240 MIDWAY RD
Mailing Address - Street 2:1303
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4923
Mailing Address - Country:US
Mailing Address - Phone:214-354-1292
Mailing Address - Fax:
Practice Address - Street 1:18240 MIDWAY RD
Practice Address - Street 2:1303
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4923
Practice Address - Country:US
Practice Address - Phone:214-354-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108963225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology