Provider Demographics
NPI:1528025533
Name:ESPENMILLER, JESSICA A (OTRL)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:ESPENMILLER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:JOHANNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-0461
Mailing Address - Country:US
Mailing Address - Phone:515-382-3366
Mailing Address - Fax:515-382-1576
Practice Address - Street 1:1507 NORTH 1ST ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125
Practice Address - Country:US
Practice Address - Phone:515-961-7435
Practice Address - Fax:515-961-7436
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06604OtherBCBS GR
IA06590OtherBCBS IND
IA06594OtherBCBS ALTOMA