Provider Demographics
NPI:1457005415
Name:NATHAN, JESSICA JANESE (OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANESE
Last Name:NATHAN
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 1:9823 SW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-3541
Mailing Address - Country:US
Mailing Address - Phone:352-256-7523
Mailing Address - Fax:
Practice Address - Street 1:2743 SMITH RANCH RD STE 302&1202
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5204
Practice Address - Country:US
Practice Address - Phone:832-598-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122401225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist