Provider Demographics
NPI:1114087004
Name:IAMS, JESSICA MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MICHELLE
Last Name:IAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2534
Mailing Address - Country:US
Mailing Address - Phone:614-586-1305
Mailing Address - Fax:614-586-1307
Practice Address - Street 1:2736 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2534
Practice Address - Country:US
Practice Address - Phone:614-586-1305
Practice Address - Fax:614-586-1307
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 9648174400000X
OHPT009648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2649754Medicaid
OH4057976Medicare ID - Type Unspecified