Provider Demographics
NPI:1558764035
Name:THOMPSON, JESSICA STOCKTON (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:STOCKTON
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 BLUFF VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-6604
Mailing Address - Country:US
Mailing Address - Phone:404-630-2200
Mailing Address - Fax:
Practice Address - Street 1:4640 MARTIN ROAD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5571
Practice Address - Country:US
Practice Address - Phone:678-679-1261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist