Healthcare Provider Details

I. General information

NPI: 1891143285
Provider Name (Legal Business Name): JESSICA HOPE SWENSEN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST SUITE 570
EUGENE OR
97401-8122
US

IV. Provider business mailing address

1200 HILYARD ST SUITE 570
EUGENE OR
97401-8122
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7070
  • Fax: 458-205-7089
Mailing address:
  • Phone: 458-205-7070
  • Fax: 458-205-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number357709
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: