Provider Demographics
NPI:1760019392
Name:YAUCH, JESSICA L (OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:YAUCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17269 SE 260TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8247
Mailing Address - Country:US
Mailing Address - Phone:386-562-4202
Mailing Address - Fax:
Practice Address - Street 1:600 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5832
Practice Address - Country:US
Practice Address - Phone:386-734-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20703225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner