Provider Demographics
NPI:1225461676
Name:SCOTT, JESSICA L (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13114 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2439
Mailing Address - Country:US
Mailing Address - Phone:708-824-0515
Mailing Address - Fax:708-824-0516
Practice Address - Street 1:13114 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2439
Practice Address - Country:US
Practice Address - Phone:708-824-0515
Practice Address - Fax:708-824-0516
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096003136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist