Provider Demographics
NPI:1538943592
Name:ALDRICH, JAKE (MOT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:ALDRICH
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-9541
Mailing Address - Country:US
Mailing Address - Phone:937-291-3780
Mailing Address - Fax:
Practice Address - Street 1:300 WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:MI
Practice Address - Zip Code:49065-9541
Practice Address - Country:US
Practice Address - Phone:937-291-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist