MEDICARE: MRS. JESSICA ANN KINCAID

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1780998914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA ANN KINCAID

Provider Business Mailing Address
First Line	:	2708 NE 14TH ST APT 5
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-3564
Country	:	US
Telephone Number	:	954-603-7885
Fax Number	:	954-342-0273

Provider Business Practice Location Address
First Line	:	1432 ADKIN DR
Second Line	:
City	:	IRON STATION
State	:	NC
Zip	:	28080-8404
Country	:	US
Telephone Number	:	704-735-9693
Fax Number	:

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

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	07/29/2010

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