Provider Demographics
NPI:1073067187
Name:SUAREZ, JESSELYN (COTA, CLT)
Entity Type:Individual
Prefix:
First Name:JESSELYN
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:COTA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 JOG RD STE B8
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1246
Mailing Address - Country:US
Mailing Address - Phone:561-495-7171
Mailing Address - Fax:
Practice Address - Street 1:15200 JOG RD STE B8
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1246
Practice Address - Country:US
Practice Address - Phone:561-495-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15053224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant