Provider Demographics
NPI:1568746949
Name:GAJESKI, JESSICA LYNN (LOTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:GAJESKI
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 STUBBS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5580
Mailing Address - Country:US
Mailing Address - Phone:318-388-8414
Mailing Address - Fax:318-388-8558
Practice Address - Street 1:803 STUBBS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5580
Practice Address - Country:US
Practice Address - Phone:318-388-8414
Practice Address - Fax:318-388-8558
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist