Healthcare Provider Details

I. General information

NPI: 1225882004
Provider Name (Legal Business Name): JESSICA HUFF OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 COLLEGE RD STE D
FAIRBANKS AK
99701-1749
US

IV. Provider business mailing address

PO BOX 81645
FAIRBANKS AK
99708-1645
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-5670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: