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NPI Code Detail

MEDICARE: JESSICA ROBERTS OT

MEDICARE: JESSICA ROBERTS 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
1225X00000XOccupational TherapistOT1756ME

General Provider Information

NPI Number : 1801392261
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ROBERTS OT
Provider Business Mailing Address
First Line : 50 NEW PORTLAND RD
Second Line :
City : GORHAM
State : ME
Zip : 04038-1542
Country : US
Telephone Number : 207-839-5757
Fax Number :
Provider Business Practice Location Address
First Line : 50 NEW PORTLAND RD
Second Line :
City : GORHAM
State : ME
Zip : 04038-1542
Country : US
Telephone Number : 207-839-5757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2018
Last Update Date : 04/04/2018

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