Provider Demographics
NPI:1659691731
Name:CLEAVER, JESSICA JOY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JOY
Last Name:CLEAVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:JOY
Other - Last Name:SEIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:5210 SW CORBETT AVE.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:717-261-6205
Mailing Address - Fax:
Practice Address - Street 1:5210 SW CORBETT AVE.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:717-261-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14510225700000X
HI7139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist