Provider Demographics
NPI:1760072110
Name:ANDERSON, JESSICA LEIGH (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SOUTH SHORE DRIVE
Mailing Address - Street 2:PMB #3B
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076
Mailing Address - Country:US
Mailing Address - Phone:978-337-9542
Mailing Address - Fax:
Practice Address - Street 1:20 INDUSTRIAL PARK DR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3178
Practice Address - Country:US
Practice Address - Phone:603-882-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist