Provider Demographics
NPI:1003529777
Name:DAVENPORT, JESSICA ELIZABETH JO (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELIZABETH JO
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:DR
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:780 SPRING FLOWERS TRL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5992
Mailing Address - Country:US
Mailing Address - Phone:810-357-3226
Mailing Address - Fax:
Practice Address - Street 1:3855 UPPER CREEK DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6814
Practice Address - Country:US
Practice Address - Phone:813-816-0563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23692225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist