MEDICARE: JESSICA RENA TINSLEY OTA

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
1	224Z00000X	Occupational Therapy Assistant	14978	FL

General Provider Information

NPI Number	:	1619561578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENA TINSLEY OTA

Provider Business Mailing Address
First Line	:	950 PROVIDENCE RESERVE LOOP APT 204
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2498
Country	:	US
Telephone Number	:	904-424-2582
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 PROVIDENCE RESERVE LOOP APT 204
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-2498
Country	:	US
Telephone Number	:	904-424-2582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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