Provider Demographics
NPI:1083719777
Name:TRAUTSCHOLD, JESSICA SUE (OT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SUE
Last Name:TRAUTSCHOLD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:SUE
Other - Last Name:CLAUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8183
Mailing Address - Fax:
Practice Address - Street 1:8 CITY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2558
Practice Address - Country:US
Practice Address - Phone:615-263-0155
Practice Address - Fax:615-263-0171
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3962225XH1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018002Medicaid