=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659693786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA BROOKS YANCE MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2010
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26420 KENSINGTON PL STE C
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526-5123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-517-0355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2183
-----------------------------------------------------
City | DAPHNE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36526-2183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-593-8156
-----------------------------------------------------
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 | 3189
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------