Provider Demographics
NPI:1780729152
Name:SARGINSON, JODIE KAY (OTR)
Entity type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:KAY
Last Name:SARGINSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9379 OAK RD
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48463-9745
Mailing Address - Country:US
Mailing Address - Phone:810-287-2660
Mailing Address - Fax:
Practice Address - Street 1:1660 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8819
Practice Address - Country:US
Practice Address - Phone:248-627-4084
Practice Address - Fax:248-627-4998
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist