Provider Demographics
NPI:1730699166
Name:RICKS, JAROM ARTHUR (OTR/L)
Entity type:Individual
Prefix:
First Name:JAROM
Middle Name:ARTHUR
Last Name:RICKS
Suffix:
Gender:M
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 1:7997 NW 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-1910
Mailing Address - Country:US
Mailing Address - Phone:661-703-3629
Mailing Address - Fax:
Practice Address - Street 1:16690 SW CHIPOLA RD
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1953
Practice Address - Country:US
Practice Address - Phone:850-674-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT18715225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty