Provider Demographics
NPI:1013033232
Name:LAGASSE, JESSICA MAY (COTA)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MAY
Last Name:LAGASSE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5070
Mailing Address - Country:US
Mailing Address - Phone:207-873-5018
Mailing Address - Fax:
Practice Address - Street 1:27 COOL ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5221
Practice Address - Country:US
Practice Address - Phone:207-873-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME224Z00000X224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOA1693OtherMAINE LICENCURE