Provider Demographics
NPI:1487733093
Name:OUELLETTE, JESSICA (PT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 REYNOLDS DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2317
Mailing Address - Country:US
Mailing Address - Phone:410-583-1515
Mailing Address - Fax:410-583-2491
Practice Address - Street 1:1026 CROMWELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3308
Practice Address - Country:US
Practice Address - Phone:410-583-1515
Practice Address - Fax:410-583-2491
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist