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General NPI Number Information
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NPI Number | 1275261307
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Entity Type | Organization
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Legal Business Name | JESSICA EKBERG OT LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 76 NORTHEASTERN BLVD STE 34
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City | NASHUA
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State | NH
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Zip | 03062-3174
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Country | US
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Telephone | 207-651-2496
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Fax |
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Provider Business Mailing Address
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Address Line | 128 MANCHESTER ST
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City | NASHUA
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State | NH
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Zip | 03064-1565
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Country | US
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Telephone | 207-651-2496
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Fax |
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Authorized Official
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Title or Position | CERTIFIED PELVIC FLOOR THERAPIST
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Name | JESSICA EKBERG
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Credential | OTR/L
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Telephone | 207-651-2496
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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 |
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License Number State |
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