Provider Demographics
NPI:1164826434
Name:PARKER, JESSICA (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 PERRILLOUX RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-9536
Mailing Address - Country:US
Mailing Address - Phone:985-264-6540
Mailing Address - Fax:
Practice Address - Street 1:566 PERRILLOUX RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9536
Practice Address - Country:US
Practice Address - Phone:985-264-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT200204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist