MEDICARE: MRS. JESSICA KLICK MS OTR/L

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	OT01299	RI

General Provider Information

NPI Number	:	1336696863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA KLICK MS OTR/L

Provider Business Mailing Address
First Line	:	2115 S COUNTY TRL
Second Line	:
City	:	WEST KINGSTON
State	:	RI
Zip	:	02892-1634
Country	:	US
Telephone Number	:	401-783-8568
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 S COUNTY TRL
Second Line	:
City	:	WEST KINGSTON
State	:	RI
Zip	:	02892-1634
Country	:	US
Telephone Number	:	401-783-8568
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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