Provider Demographics
NPI:1174730212
Name:HARNEY, JESSICA (DPT, OT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:HARNEY
Suffix:
Gender:F
Credentials:DPT, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HENLEY ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3835
Mailing Address - Country:US
Mailing Address - Phone:617-763-2862
Mailing Address - Fax:
Practice Address - Street 1:170 GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-395-7750
Practice Address - Fax:781-395-5343
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17543225100000X
MA8381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist