Healthcare Provider Details

I. General information

NPI: 1215251749
Provider Name (Legal Business Name): JESSICA MEVIUS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 HELSTON DR
PLANO TX
75024-3748
US

IV. Provider business mailing address

5604 BLUE SPRUCE LN
MCKINNEY TX
75070-6990
US

V. Phone/Fax

Practice location:
  • Phone: 214-566-2687
  • Fax: 866-323-1955
Mailing address:
  • Phone: 214-924-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number113703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: