Provider Demographics
NPI:1952725129
Name:PATERNOSTER, JAIME (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:PATERNOSTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8095 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-9341
Mailing Address - Country:US
Mailing Address - Phone:906-828-1263
Mailing Address - Fax:
Practice Address - Street 1:501 LAKE AVE
Practice Address - Street 2:COURTHOUSE LOWER LEVEL
Practice Address - City:FLORENCE
Practice Address - State:WI
Practice Address - Zip Code:54121-8805
Practice Address - Country:US
Practice Address - Phone:715-528-3296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3992-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist