Provider Demographics
NPI:1093217655
Name:RABBAN, JESSICA BERNADETTE (MOT, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:BERNADETTE
Last Name:RABBAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47061 GRAND RIVER AVE STE 201A
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1340
Mailing Address - Country:US
Mailing Address - Phone:248-465-4695
Mailing Address - Fax:248-465-4686
Practice Address - Street 1:47061 GRAND RIVER AVE STE 201A
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1340
Practice Address - Country:US
Practice Address - Phone:248-465-4695
Practice Address - Fax:248-465-4686
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist