Provider Demographics
NPI:1083176853
Name:CHASE, JESSICA D (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:D
Last Name:CHASE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:OAKFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04763-0164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 BANGOR ST STE A
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1603
Practice Address - Country:US
Practice Address - Phone:207-521-0200
Practice Address - Fax:207-521-0210
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4950225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant