Basic Information
| Provider Information | |||||||||
| NPI: | 1881927481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DYKES | ||||||||
| FirstName: | JINGER | ||||||||
| MiddleName: | CHERRI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1353 BUR OAK CT | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461239478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172728501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 S COUNTY ROAD 525 E | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177451390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2009 | ||||||||
| LastUpdateDate: | 09/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 31000707A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.