Provider Demographics
NPI:1073371449
Name:SIEVERS, JESSICA L (OT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:SIEVERS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAPLE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1745
Mailing Address - Country:US
Mailing Address - Phone:732-530-1164
Mailing Address - Fax:732-530-2172
Practice Address - Street 1:231 MAPLE AVE FL 2
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1745
Practice Address - Country:US
Practice Address - Phone:732-530-1164
Practice Address - Fax:732-530-2172
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01168900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty