Healthcare Provider Details

I. General information

NPI: 1689248940
Provider Name (Legal Business Name): JESSICA A BRETON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PILLSBURY ST STE 404
CONCORD NH
03301-3549
US

IV. Provider business mailing address

101 TALENT RD
LITCHFIELD NH
03052-2452
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7827
  • Fax:
Mailing address:
  • Phone: 603-689-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: