Provider Demographics
NPI:1669030763
Name:CHAVEZ-KLINE, JESSICA LAUREL (DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LAUREL
Last Name:CHAVEZ-KLINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 AUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2406
Mailing Address - Country:US
Mailing Address - Phone:513-403-8325
Mailing Address - Fax:
Practice Address - Street 1:3377 COMPTON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-2506
Practice Address - Country:US
Practice Address - Phone:513-245-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist