Provider Demographics
NPI:1376024331
Name:BACKLUND, JESI LEANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JESI
Middle Name:LEANN
Last Name:BACKLUND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-1604
Mailing Address - Country:US
Mailing Address - Phone:325-234-0752
Mailing Address - Fax:
Practice Address - Street 1:4343 OAK GROVE BLVD.
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-4500
Practice Address - Country:US
Practice Address - Phone:325-942-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist