Provider Demographics
NPI:1750510350
Name:SURFACE, JESSICA (MS, OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SURFACE
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5305
Mailing Address - Country:US
Mailing Address - Phone:843-769-0663
Mailing Address - Fax:843-769-0665
Practice Address - Street 1:1407 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5305
Practice Address - Country:US
Practice Address - Phone:843-769-0663
Practice Address - Fax:843-769-0665
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7273225X00000X
IN31004801A225X00000X
SC4130225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics