Provider Demographics
NPI:1275084485
Name:BECTON, JESSICA (OT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BECTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 931306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1306
Mailing Address - Country:US
Mailing Address - Phone:678-459-3745
Mailing Address - Fax:
Practice Address - Street 1:249 MACK BAYOU LOOP
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7198
Practice Address - Country:US
Practice Address - Phone:850-622-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16152225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation