Provider Demographics
NPI:1093215550
Name:SCHILLER, JESSICA LEE (OT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE
Last Name:SCHILLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:DOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5655 W 35TH ST APT 216
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5528
Mailing Address - Country:US
Mailing Address - Phone:952-451-9652
Mailing Address - Fax:
Practice Address - Street 1:10273 YELLOW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9144
Practice Address - Country:US
Practice Address - Phone:952-223-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105584225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist