Provider Demographics
NPI:1467695288
Name:PIPKIN, JESSICA WOODARD (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:WOODARD
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1013 RIVERBURCH PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8887
Mailing Address - Country:US
Mailing Address - Phone:866-261-8090
Mailing Address - Fax:706-226-7869
Practice Address - Street 1:1013 RIVERBURCH PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8887
Practice Address - Country:US
Practice Address - Phone:866-261-8090
Practice Address - Fax:706-226-7869
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001054224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant