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NPI Code Detail

MEDICARE: JESSICA OPPENHUIZEN MOT

MEDICARE: JESSICA OPPENHUIZEN MOT
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
1225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1588010078
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA OPPENHUIZEN MOT
Provider Business Mailing Address
First Line : 146 TIMBER CREEK DR STE 1
Second Line :
City : CORDOVA
State : TN
Zip : 38018-4395
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 146 TIMBER CREEK DR STE 101
Second Line :
City : CORDOVA
State : TN
Zip : 38018-4396
Country : US
Telephone Number : 901-401-0065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2016
Last Update Date : 01/27/2025

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