Provider Demographics
NPI:1467095455
Name:CARUSO, JESSICA NICOLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PITCAIRN
Mailing Address - State:PA
Mailing Address - Zip Code:15140-1104
Mailing Address - Country:US
Mailing Address - Phone:412-651-4940
Mailing Address - Fax:
Practice Address - Street 1:7060 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-1259
Practice Address - Country:US
Practice Address - Phone:412-404-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC016439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist