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General NPI Number Information
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NPI Number | 1750646535
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Entity Type | Individual
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Provider Name | JESSICA PINO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 5959 SHALLOWFORD RD STE 215
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2285
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Country | US
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Telephone | 423-894-4774
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Fax | 423-894-4775
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Provider Business Mailing Address
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Address Line | PO BOX 903
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City | HIXSON
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State | TN
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Zip | 37343-0903
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Country | US
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Telephone | 423-894-4774
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Fax | 423-894-4775
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT4462
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License Number State | TN
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