Provider Demographics
NPI:1083262596
Name:ROBINSON, JESSICA G
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:G
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 NE LOTUS DR APT 4
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5035
Mailing Address - Country:US
Mailing Address - Phone:541-706-0676
Mailing Address - Fax:
Practice Address - Street 1:999 SW DISK DR STE 105
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3060
Practice Address - Country:US
Practice Address - Phone:541-639-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist