MEDICARE: JESSY JOSEPH

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	224Z00000X	Occupational Therapy Assistant	215167	TX

General Provider Information

NPI Number	:	1235527078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSY JOSEPH

Provider Business Mailing Address
First Line	:	2011 SAN MARINO LN
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75077-3346
Country	:	US
Telephone Number	:	122-443-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 SAN MARINO LN
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75077-3346
Country	:	US
Telephone Number	:	122-443-3347
Fax Number	:

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

Provider Enumeration Date	:	01/01/2015
Last Update Date	:	03/20/2024

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Directions to “ JESSY JOSEPH ” Practice Location

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