Provider Demographics
NPI:1023193802
Name:CASEY, JESSICA TAYLOR (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:TAYLOR
Last Name:CASEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 DOVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7525
Mailing Address - Country:US
Mailing Address - Phone:859-333-0819
Mailing Address - Fax:
Practice Address - Street 1:613 DOVE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7525
Practice Address - Country:US
Practice Address - Phone:859-333-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1708174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist