Provider Demographics
NPI:1063670404
Name:WOODS, JESSICA S (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:S
Last Name:WOODS
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 1:11443 N 91ST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-5550
Mailing Address - Country:US
Mailing Address - Phone:928-910-9394
Mailing Address - Fax:
Practice Address - Street 1:14154 S DENNY BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9431
Practice Address - Country:US
Practice Address - Phone:623-537-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-31
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001614A224Z00000X
AZ4158224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant