Provider Demographics
NPI:1134305840
Name:TSOTSOROS, JESSICA DAWN (MS OTR/L ATP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DAWN
Last Name:TSOTSOROS
Suffix:
Gender:F
Credentials:MS OTR/L ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:7770 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2729
Mailing Address - Country:US
Mailing Address - Phone:918-698-7461
Mailing Address - Fax:
Practice Address - Street 1:7770 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-2729
Practice Address - Country:US
Practice Address - Phone:918-698-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1035225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics