Provider Demographics
NPI:1457650889
Name:JORDAN, VANESSA (OTR)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:JORDAN
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 1:250 E DEBBIE LANE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3852
Mailing Address - Country:US
Mailing Address - Phone:682-518-8547
Mailing Address - Fax:
Practice Address - Street 1:250 E DEBBIE LANE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3852
Practice Address - Country:US
Practice Address - Phone:682-518-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist