Provider Demographics
NPI:1487156550
Name:AUKEMA, JESSICA MARY (COTA/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARY
Last Name:AUKEMA
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 1:9 BROWN ST # 1
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101-1457
Mailing Address - Country:US
Mailing Address - Phone:216-333-5628
Mailing Address - Fax:
Practice Address - Street 1:105 CHESTER RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2106
Practice Address - Country:US
Practice Address - Phone:802-885-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.0132473224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant