Provider Demographics
NPI:1538640107
Name:FOOS, JESSICA KAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:FOOS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 HOLLY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1406
Mailing Address - Country:US
Mailing Address - Phone:419-806-5199
Mailing Address - Fax:
Practice Address - Street 1:HEBREW HOME OF GREATER WASHINGTON
Practice Address - Street 2:6121 MONTROSE RD
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-881-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02539224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant