Provider Demographics
NPI:1235756719
Name:CARTER, JESSICA LONG (OTD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LONG
Last Name:CARTER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2924 JOHN OAKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27314-9408
Mailing Address - Country:US
Mailing Address - Phone:336-504-2520
Mailing Address - Fax:
Practice Address - Street 1:323 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2715
Practice Address - Country:US
Practice Address - Phone:336-229-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist