Healthcare Provider Details

I. General information

NPI: 1912432220
Provider Name (Legal Business Name): JESSICA CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CHESAPEAKE DR
TARPON SPRINGS FL
34689-2515
US

IV. Provider business mailing address

7616 W COURTNEY CAMPBELL CSWY UNIT 251
TAMPA FL
33607-1538
US

V. Phone/Fax

Practice location:
  • Phone: 727-934-4629
  • Fax:
Mailing address:
  • Phone: 407-334-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number0210501
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: