Provider Demographics
NPI:1750646535
Name:PINO, JESSICA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:PINO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-0903
Mailing Address - Country:US
Mailing Address - Phone:423-894-4774
Mailing Address - Fax:423-894-4775
Practice Address - Street 1:5959 SHALLOWFORD RD
Practice Address - Street 2:STE 215
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2285
Practice Address - Country:US
Practice Address - Phone:423-894-4774
Practice Address - Fax:423-894-4775
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT4462225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics