Provider Demographics
NPI:1649231952
Name:WEST, JESSI MOUNCE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JESSI
Middle Name:MOUNCE
Last Name:WEST
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:LEIGH
Other - Last Name:MOUNCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:3303 HWY 70 EAST
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560
Mailing Address - Country:US
Mailing Address - Phone:252-672-8680
Mailing Address - Fax:252-637-4812
Practice Address - Street 1:3303 HWY 70 EAST
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560
Practice Address - Country:US
Practice Address - Phone:252-672-8680
Practice Address - Fax:252-637-4812
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5914225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC388569919OtherTRICARE
NC7301536Medicaid