Provider Demographics
NPI:1174847990
Name:SLATER, JESSICA LYNN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SLATER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 JEFFERSON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4244
Mailing Address - Country:US
Mailing Address - Phone:810-348-5051
Mailing Address - Fax:
Practice Address - Street 1:9100 LAPEER RD
Practice Address - Street 2:SUITE C
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-3620
Practice Address - Country:US
Practice Address - Phone:810-653-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1630006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist