Provider Demographics
NPI:1740166321
Name:ARVIN, JORDAN M (COTA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:M
Last Name:ARVIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:704 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4392
Mailing Address - Country:US
Mailing Address - Phone:812-228-0365
Mailing Address - Fax:
Practice Address - Street 1:704 MARTIN LN
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4392
Practice Address - Country:US
Practice Address - Phone:812-228-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
32003692A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant