Provider Demographics
NPI:1275261307
Name:JESSICA EKBERG OT LLC
Entity Type:Organization
Organization Name:JESSICA EKBERG OT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PELVIC FLOOR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:EKBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-651-2496
Mailing Address - Street 1:128 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-1565
Mailing Address - Country:US
Mailing Address - Phone:207-651-2496
Mailing Address - Fax:
Practice Address - Street 1:76 NORTHEASTERN BLVD STE 34
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3174
Practice Address - Country:US
Practice Address - Phone:207-651-2496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty