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General NPI Number Information
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NPI Number | 1548912801
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Entity Type | Individual
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Provider Name | JESSICA JOHANNA CHEEVERS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 766 BUCHANAN RD
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City | BRANSON
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State | MO
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Zip | 65616-9946
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Country | US
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Telephone | 417-298-0168
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 STATE HIGHWAY JJ
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City | SPARTA
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State | MO
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Zip | 65753-9182
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Country | US
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Telephone |
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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 | 2022006865
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License Number State | MO
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