Healthcare Provider Details

I. General information

NPI: 1881133254
Provider Name (Legal Business Name): JESSIE STEELE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2017
Last Update Date: 02/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2693 NW CROSSING DR
BEND OR
97703-7347
US

IV. Provider business mailing address

2693 NW CROSSING DR
BEND OR
97703-7347
US

V. Phone/Fax

Practice location:
  • Phone: 920-475-8587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number352752
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: