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General NPI Number Information
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NPI Number | 1932082450
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Entity Type | Individual
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Provider Name | JESSICA LORRAINE CEARLEY
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Gender | Female
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 805 AMERMAN DR
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City | PHOENIX
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State | OR
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Zip | 97535-7729
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Country | US
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Telephone | 458-291-1603
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Fax |
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Provider Business Mailing Address
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Address Line | 82 MAPLE ST
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City | SHADY COVE
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State | OR
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Zip | 97539-9843
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Country | US
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Telephone | 458-658-9772
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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