Healthcare Provider Details

I. General information

NPI: 1912854019
Provider Name (Legal Business Name): JESSICA PEYTON MUSGROVE MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ASHOURIAN AVE STE 105
SAINT AUGUSTINE FL
32092-5106
US

IV. Provider business mailing address

104 ASHOURIAN AVE STE 105
SAINT AUGUSTINE FL
32092-5106
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-7761
  • Fax:
Mailing address:
  • Phone: 904-230-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: