Healthcare Provider Details

I. General information

NPI: 1205767878
Provider Name (Legal Business Name): JESULA ANDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 FOREST RIDGE DR STE 1
ROWLEY MA
01969-2151
US

IV. Provider business mailing address

7 PLEASANT ST
MERRIMAC MA
01860-1945
US

V. Phone/Fax

Practice location:
  • Phone: 978-356-0315
  • Fax:
Mailing address:
  • Phone: 978-914-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTL36226
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: