Provider Demographics
NPI:1659400521
Name:VAN HANDEL, JESSICA AMBER (OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:AMBER
Last Name:VAN HANDEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:AMBER
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:325 E. FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:920-738-4870
Mailing Address - Fax:920-759-1937
Practice Address - Street 1:325 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-738-4870
Practice Address - Fax:920-759-1937
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4357-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1075010OtherNBCOTA
WI4357-026OtherSTATE OF WI
WI40900600Medicaid