MEDICARE: MS. JESSICA LYN PIOTRACZK OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT12760	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT12760	OTHER	FL	FLORIDA LICENSE

General Provider Information

NPI Number	:	1194928085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA LYN PIOTRACZK OT

Provider Business Mailing Address
First Line	:	2440 HOOKS ST
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-3514
Country	:	US
Telephone Number	:	352-394-2862
Fax Number	:	352-394-2861

Provider Business Practice Location Address
First Line	:	2440 HOOKS ST
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-3514
Country	:	US
Telephone Number	:	352-394-2862
Fax Number	:	352-394-2861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/10/2026

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