Provider Demographics
NPI:1376144691
Name:LAW, JESSICA (OTR/L, CLT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 FIELDSTONE DR N
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8113
Mailing Address - Country:US
Mailing Address - Phone:630-335-0069
Mailing Address - Fax:
Practice Address - Street 1:9445 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2811
Practice Address - Country:US
Practice Address - Phone:219-217-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008094A225X00000X
IL056.013913225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist