Provider Demographics
NPI:1386034254
Name:CARTER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 LEE ROAD 342
Mailing Address - Street 2:
Mailing Address - City:LEXA
Mailing Address - State:AR
Mailing Address - Zip Code:72355-8948
Mailing Address - Country:US
Mailing Address - Phone:870-662-2980
Mailing Address - Fax:
Practice Address - Street 1:461 LEE ROAD 342
Practice Address - Street 2:
Practice Address - City:LEXA
Practice Address - State:AR
Practice Address - Zip Code:72355-8948
Practice Address - Country:US
Practice Address - Phone:870-662-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT2015-010224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant