Provider Demographics
NPI:1306446562
Name:BASKIN, JESSICA (COTA/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BASKIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 ANO NUEVO AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-1620
Mailing Address - Country:US
Mailing Address - Phone:916-402-7283
Mailing Address - Fax:
Practice Address - Street 1:2500 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5356
Practice Address - Country:US
Practice Address - Phone:510-792-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4829224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant