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General NPI Number Information
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NPI Number | 1114621414
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Entity Type | Individual
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Provider Name | JESSICA GARDNER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 2557 PEMBROKE RD
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City | GASTONIA
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State | NC
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Zip | 28054-4712
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Country | US
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Telephone | 980-320-8275
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 FIELD SWALLOW WAY
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City | CLOVER
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State | SC
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Zip | 29710-8882
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Country | US
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Telephone | 803-627-3862
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | .6790
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 15781
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License Number State | NC
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