Provider Demographics
NPI:1902462765
Name:O'BRIEN, JESSICA (OTR, MOT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR, MOT
Mailing Address - Street 1:525 S LOCUST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6136
Mailing Address - Country:US
Mailing Address - Phone:940-600-7527
Mailing Address - Fax:940-383-1251
Practice Address - Street 1:525 S LOCUST ST STE 200
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6136
Practice Address - Country:US
Practice Address - Phone:940-600-7527
Practice Address - Fax:940-383-1251
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist