MEDICARE: JESSICA TIONGSON O.T.R.

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	103885	TX

General Provider Information

NPI Number	:	1679889935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TIONGSON O.T.R.

Provider Business Mailing Address
First Line	:	9101 WARM SPRINGS CIR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7058
Country	:	US
Telephone Number	:	469-939-3438
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 WARM SPRINGS CIR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7058
Country	:	US
Telephone Number	:	469-939-3438
Fax Number	:

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

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	03/27/2015

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