Provider Demographics
NPI:1407163520
Name:TYLER, JESSICA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:TYLER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 FREE STATE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2832
Mailing Address - Country:US
Mailing Address - Phone:316-259-7658
Mailing Address - Fax:
Practice Address - Street 1:4712 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2272
Practice Address - Country:US
Practice Address - Phone:785-272-6510
Practice Address - Fax:785-271-9430
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist