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General NPI Number Information
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NPI Number | 1942884531
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Entity Type | Individual
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Provider Name | JESSICA LYNN MCENANEY OTR
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1669 NORWOOD RD
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City | STATESVILLE
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State | NC
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Zip | 28677-8201
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Country | US
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Telephone | 704-746-9698
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Fax | 704-662-3304
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Provider Business Mailing Address
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Address Line | 249 WILLIAMSON RD
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City | MOORESVILLE
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State | NC
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Zip | 28117-8195
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Country | US
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Telephone | 704-746-9698
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Fax | 704-662-3304
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14010
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 14010
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License Number State | NC
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