Provider Demographics
NPI:1417511452
Name:ROMERO, JESSICA (OT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1727 IMPERIAL BLVD.
Mailing Address - Street 2:BLDG # 3
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5393
Mailing Address - Country:US
Mailing Address - Phone:337-478-5880
Mailing Address - Fax:337-478-5879
Practice Address - Street 1:1727 IMPERIAL BLVD.
Practice Address - Street 2:BLDG # 3
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5393
Practice Address - Country:US
Practice Address - Phone:337-478-5880
Practice Address - Fax:337-478-5879
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA311808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist