Provider Demographics
NPI:1689693988
Name:STANFORD, JESSICA ELIZABETH (OTR/L CHT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:STANFORD
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:961A SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5602
Mailing Address - Country:US
Mailing Address - Phone:831-635-1135
Mailing Address - Fax:
Practice Address - Street 1:961A SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5602
Practice Address - Country:US
Practice Address - Phone:831-635-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2693225XH1200X
CAOT 2693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT 2693OtherOT LICENSE
CAZZZ02630ZOtherMEDICARE PROVIDER NUMBER
CAZZZ02630ZOtherMEDICARE PROVIDER NUMBER