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NPI Code Detail

MEDICARE: JESSICA DIANE ROYAL MS, OTR/L

MEDICARE: JESSICA DIANE ROYAL MS, OTR/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
1225X00000XOccupational TherapistOT010001522DC
2225X00000XOccupational TherapistOT0000007113TN

General Provider Information

NPI Number : 1841767365
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DIANE ROYAL MS, OTR/L
Provider Business Mailing Address
First Line : 1305 16TH AVE S
Second Line :
City : NASHVILLE
State : TN
Zip : 37212-2923
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1305 16TH AVE S
Second Line :
City : NASHVILLE
State : TN
Zip : 37212-2923
Country : US
Telephone Number : 615-578-7411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 08/09/2023

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