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NPI Code Detail

MEDICARE: JESSICA DELONG OTA/L

MEDICARE: JESSICA DELONG OTA/L
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
1224Z00000XOccupational Therapy Assistant1162OK

General Provider Information

NPI Number : 1134390388
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DELONG OTA/L
Provider Business Mailing Address
First Line : 14715 BRISTOL PARK BLVD
Second Line :
City : EDMOND
State : OK
Zip : 73013-1894
Country : US
Telephone Number : 405-840-1686
Fax Number : 405-840-1006
Provider Business Practice Location Address
First Line : 14715 BRISTOL PARK BLVD
Second Line :
City : EDMOND
State : OK
Zip : 73013-1894
Country : US
Telephone Number : 405-840-1686
Fax Number : 405-840-1006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2008
Last Update Date : 02/03/2022

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Directions to “ JESSICA DELONG OTA/L” Practice Location

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