Provider Demographics
NPI:1568185049
Name:CROWSON, JESSICA ROSELLA (MOT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSELLA
Last Name:CROWSON
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9585 E 350 RD
Mailing Address - Street 2:
Mailing Address - City:TALALA
Mailing Address - State:OK
Mailing Address - Zip Code:74080-9511
Mailing Address - Country:US
Mailing Address - Phone:918-724-9096
Mailing Address - Fax:
Practice Address - Street 1:14701 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8474
Practice Address - Country:US
Practice Address - Phone:918-205-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist