Provider Demographics
NPI:1417737560
Name:WEBB, JORDAN MICHELE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHELE
Last Name:WEBB
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 RINGWALD ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1543
Mailing Address - Country:US
Mailing Address - Phone:740-701-1541
Mailing Address - Fax:
Practice Address - Street 1:310 E WARDELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7997
Practice Address - Country:US
Practice Address - Phone:910-521-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
NC224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant