Provider Demographics
NPI:1740411404
Name:JARAMILLO, TOM (OTR)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0924
Mailing Address - Country:US
Mailing Address - Phone:785-207-4109
Mailing Address - Fax:
Practice Address - Street 1:577 S PEACH AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3952
Practice Address - Country:US
Practice Address - Phone:559-251-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1800457225X00000X
26850225X00000X
CA26850225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist