Provider Demographics
NPI:1114406238
Name:LITTRELL, JESSICA ROBYN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROBYN
Last Name:LITTRELL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24750 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:IN
Mailing Address - Zip Code:46030-9435
Mailing Address - Country:US
Mailing Address - Phone:317-385-2123
Mailing Address - Fax:
Practice Address - Street 1:6437 RUCKER RD STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4868
Practice Address - Country:US
Practice Address - Phone:317-405-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006689A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist