=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528697208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA THORNTON MS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2020
-----------------------------------------------------
Last Update Date | 04/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 322 LOS GATOS SARATOGA RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95030-5318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-647-2084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 184 MERRITT RD
-----------------------------------------------------
City | LOS ALTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94022-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-387-3733
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 18483
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------