Provider Demographics
NPI:1548651227
Name:JOSEPH, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 TURNER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5721
Mailing Address - Country:US
Mailing Address - Phone:321-622-8792
Mailing Address - Fax:321-622-8793
Practice Address - Street 1:7145 TURNER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5721
Practice Address - Country:US
Practice Address - Phone:321-622-8792
Practice Address - Fax:321-622-8793
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist