Provider Demographics
NPI:1174756225
Name:WESTHOVEN, JESSICA ALICIA (LMT, PTA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ALICIA
Last Name:WESTHOVEN
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1414
Mailing Address - Country:US
Mailing Address - Phone:419-966-0959
Mailing Address - Fax:
Practice Address - Street 1:2245 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1414
Practice Address - Country:US
Practice Address - Phone:419-966-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.017688225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist