Provider Demographics
NPI:1538453758
Name:BESS, JACLYNN LOUISE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JACLYNN
Middle Name:LOUISE
Last Name:BESS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4152 WHIM SHAFT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7319
Mailing Address - Country:US
Mailing Address - Phone:908-334-9506
Mailing Address - Fax:
Practice Address - Street 1:4152 WHIM SHAFT DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7319
Practice Address - Country:US
Practice Address - Phone:908-334-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4126225XP0200X
NC7740225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6269Medicaid
SCTH2654Medicaid