Provider Demographics
NPI:1144691015
Name:BROPHY, JESSICA BUSAN (OTR/L, LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BUSAN
Last Name:BROPHY
Suffix:
Gender:F
Credentials:OTR/L, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 ACORN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3004
Mailing Address - Country:US
Mailing Address - Phone:408-355-5430
Mailing Address - Fax:
Practice Address - Street 1:2100 FOREST AVE STE 111
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1422
Practice Address - Country:US
Practice Address - Phone:408-355-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19919171100000X
CAOTR/L 15191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171100000XOther Service ProvidersAcupuncturist