Provider Demographics
NPI:1487150405
Name:BLISSETT, JESSI JONES (COTA/L)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:JONES
Last Name:BLISSETT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EMRY CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7784
Mailing Address - Country:US
Mailing Address - Phone:601-826-6843
Mailing Address - Fax:
Practice Address - Street 1:106 EMRY CV
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7784
Practice Address - Country:US
Practice Address - Phone:601-826-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA3126224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant