Provider Demographics
NPI:1538660840
Name:DOTSON, JESSICA MCCLELLAND (COTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MCCLELLAND
Last Name:DOTSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 AIRPORT FWY STE 372
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6873
Mailing Address - Country:US
Mailing Address - Phone:817-595-2955
Mailing Address - Fax:817-595-5764
Practice Address - Street 1:1600 AIRPORT FWY STE 372
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6873
Practice Address - Country:US
Practice Address - Phone:817-595-2955
Practice Address - Fax:817-595-5764
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214300224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty