Provider Demographics
NPI:1205404241
Name:JESSICA HEBERT OT, LLC
Entity Type:Organization
Organization Name:JESSICA HEBERT OT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:781-414-9777
Mailing Address - Street 1:597 OLD DUNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1505
Mailing Address - Country:US
Mailing Address - Phone:781-414-9777
Mailing Address - Fax:
Practice Address - Street 1:597 OLD DUNSTABLE RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1505
Practice Address - Country:US
Practice Address - Phone:781-414-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center