MR. Jefferson James Mahinay Licup, OTR/L

NPI #1437484110 in Bolingbrook, Illinois

Provider Information

NPI Number: 1437484110
Entity Type: Individual
Name: MR. Jefferson James Mahinay Licup, OTR/L
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Occupational Therapist
Credential: OTR/L
Enumeration Date: Oct 13, 2009
Last Updated: Oct 13, 2009

Practice Location

Address: 226 TIGER ST
City: Bolingbrook
State: Illinois
ZIP Code: 60490-2053
Phone: (708) 822-8886

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X	Primary

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