Provider Demographics
NPI:1326489964
Name:CASTOR, JESSICA A (COTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:CASTOR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 W 1800 S
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47977-8609
Mailing Address - Country:US
Mailing Address - Phone:219-869-1060
Mailing Address - Fax:
Practice Address - Street 1:4855 W 1800 S
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47977-8609
Practice Address - Country:US
Practice Address - Phone:219-869-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002452A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant