Provider Demographics
NPI:1093182735
Name:KUEBEL, JESSICA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KUEBEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:IL
Mailing Address - Zip Code:61230
Mailing Address - Country:US
Mailing Address - Phone:815-973-7899
Mailing Address - Fax:
Practice Address - Street 1:9441 LBJ FWY
Practice Address - Street 2:SUITE 602
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4545
Practice Address - Country:US
Practice Address - Phone:469-249-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004336224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant