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General NPI Number Information
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NPI Number | 1972917110
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Entity Type | Individual
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Provider Name | JESSICA MARLENE OAKLAND PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1125 N 13TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3281
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Country | US
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Telephone | 920-803-1617
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Fax | 920-803-1622
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Provider Business Mailing Address
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Address Line | 1125 N 13TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3281
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Country | US
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Telephone | 920-803-1617
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Fax | 920-803-1622
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12743-24
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License Number State | WI
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