Provider Demographics
NPI:1437474053
Name:HUNT, JESSICA (OTRL)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 DALY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3410
Mailing Address - Country:US
Mailing Address - Phone:248-737-3430
Mailing Address - Fax:248-737-3433
Practice Address - Street 1:6625 DALY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3410
Practice Address - Country:US
Practice Address - Phone:248-737-3430
Practice Address - Fax:248-737-3433
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006760225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics