Provider Demographics
NPI:1447403407
Name:PARKS, JESSICA A (OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:PARKS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1201
Mailing Address - Country:US
Mailing Address - Phone:607-592-0669
Mailing Address - Fax:
Practice Address - Street 1:491 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1201
Practice Address - Country:US
Practice Address - Phone:607-592-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014874225XP0200X
NJ46TR00842100225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics