Provider Demographics
NPI:1861562290
Name:OCONNOR, JESSICA E (PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2498
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0922
Mailing Address - Country:US
Mailing Address - Phone:508-221-0583
Mailing Address - Fax:
Practice Address - Street 1:35 BRUSHBROOM LANE
Practice Address - Street 2:
Practice Address - City:WEST TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02575
Practice Address - Country:US
Practice Address - Phone:508-221-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MH15457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist