Provider Demographics
NPI:1609195759
Name:STRAUSS, JESSICA NICOLE
Entity Type:Individual
Prefix:MR
First Name:JESSICA
Middle Name:NICOLE
Last Name:STRAUSS
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 1:942 W SHELBY DR N
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:IN
Mailing Address - Zip Code:47452-9306
Mailing Address - Country:US
Mailing Address - Phone:812-653-0404
Mailing Address - Fax:
Practice Address - Street 1:200 CONNIE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2306
Practice Address - Country:US
Practice Address - Phone:812-653-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001603A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant