Provider Demographics
NPI:1730511668
Name:BEVINS, JESSICA LYNN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNN
Last Name:BEVINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 MACEDO RD NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2645
Mailing Address - Country:US
Mailing Address - Phone:321-514-7997
Mailing Address - Fax:
Practice Address - Street 1:2040 FLORIDA HWY A1A
Practice Address - Street 2:SUITE 203
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937
Practice Address - Country:US
Practice Address - Phone:321-773-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12363224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant