Provider Demographics
NPI:1043573306
Name:SMITH, JESSICA MARIE (OTRL)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ANDRUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5060 JACKSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1867
Mailing Address - Country:US
Mailing Address - Phone:734-627-8001
Mailing Address - Fax:734-433-1989
Practice Address - Street 1:5060 JACKSON RD STE D
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1867
Practice Address - Country:US
Practice Address - Phone:734-627-8001
Practice Address - Fax:734-433-1989
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007923225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist