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General NPI Number Information
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NPI Number | 1417449620
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Entity Type | Individual
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Provider Name | JESSICA DIANNE PEDRYS MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 261 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2417
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Country | US
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Telephone | 313-745-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 21741 EDMUNTON ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-3526
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Country | US
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Telephone | 810-292-5033
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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 | 5201008095
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License Number State | MI
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