Provider Demographics
NPI:1710494224
Name:LANE, JESSICA LAUREN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 COUNTRY RUN CIR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5428
Mailing Address - Country:US
Mailing Address - Phone:865-228-1037
Mailing Address - Fax:
Practice Address - Street 1:408 COUNTRY RUN CIR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5428
Practice Address - Country:US
Practice Address - Phone:865-228-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty