Individual
SOPHIE JAKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-4088
(315) 786-4847
Mailing address
522 WASHINGTON ST, APT 202, WATERTOWN, NY 13601-4053
(315) 767-8584
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT 11501
FL
225XP0200X
Pediatric Occupational Therapist
Primary
009270-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890272100
—
FL
01
—
OT 11501
OCCUPATIONAL THERAPY
FL
01
—
Z088D
BCBS
FL
Enumeration date
06/23/2006
Last updated
01/27/2009
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