Provider Demographics
NPI:1508267519
Name:KLINE, JESSELYNE (MSOT)
Entity Type:Individual
Prefix:
First Name:JESSELYNE
Middle Name:
Last Name:KLINE
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 GEISSINGER AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9653
Mailing Address - Country:US
Mailing Address - Phone:609-364-1908
Mailing Address - Fax:
Practice Address - Street 1:239 GEISSINGER AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-9653
Practice Address - Country:US
Practice Address - Phone:609-364-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00655400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist