Provider Demographics
NPI:1174298848
Name:DAIGNEAULT, JESSICA MAXINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAXINE
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1572
Mailing Address - Country:US
Mailing Address - Phone:413-426-5708
Mailing Address - Fax:
Practice Address - Street 1:298 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1288
Practice Address - Country:US
Practice Address - Phone:413-538-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005213225X00000X
MA13140225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist