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NPI Code Detail

MEDICARE: TONI RENEE JESSOP OT

MEDICARE: TONI RENEE JESSOP OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist02049MD
2174400000XSpecialist2049MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11063460723OTHERMDPRIVATE INSURANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063460723
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONI RENEE JESSOP OT
Provider Business Mailing Address
First Line : 7003 PINECREST RD
Second Line :
City : BALTIMORE
State : MD
Zip : 21228-1041
Country : US
Telephone Number : 443-562-5219
Fax Number :
Provider Business Practice Location Address
First Line : 1836 GREENE TREE RD
Second Line :
City : PIKESVILLE
State : MD
Zip : 21208-1381
Country : US
Telephone Number : 410-486-9992
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 03/27/2020

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