Provider Demographics
NPI:1598055436
Name:JEPPSON, BARBARA A
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:JEPPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 COFFEE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1305
Mailing Address - Country:US
Mailing Address - Phone:209-549-4626
Mailing Address - Fax:209-549-4625
Practice Address - Street 1:3500 COFFEE RD
Practice Address - Street 2:STE 3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1305
Practice Address - Country:US
Practice Address - Phone:209-549-4626
Practice Address - Fax:209-549-4625
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7158225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist