Healthcare Provider Details

I. General information

NPI: 1528921863
Provider Name (Legal Business Name): DREAMA JESSUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 ANDREWS AVE STE C
OZARK AL
36360-1741
US

IV. Provider business mailing address

151 WOODBERRY DR
ENTERPRISE AL
36330-1657
US

V. Phone/Fax

Practice location:
  • Phone: 334-406-4520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: