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General NPI Number Information
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NPI Number | 1730785825
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Entity Type | Individual
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Provider Name | JESSICA CHRISTIAN FAIRCLOTH OTR/L
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Gender | Female
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 1830 OWEN DR STE 103
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3412
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Country | US
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Telephone | 910-748-0258
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Fax |
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Provider Business Mailing Address
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Address Line | 338 HILLIARD DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-2648
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Country | US
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Telephone | 910-494-0222
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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 | 13735
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License Number State | NC
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