Provider Demographics
NPI:1760825178
Name:TOLER-ELAYAZRA, JESSICA L (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:TOLER-ELAYAZRA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 WICHITA CT
Mailing Address - Street 2:APT 23
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-6462
Mailing Address - Country:US
Mailing Address - Phone:304-890-3924
Mailing Address - Fax:
Practice Address - Street 1:7350 WICHITA CT
Practice Address - Street 2:APT 23
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-6462
Practice Address - Country:US
Practice Address - Phone:304-890-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001129224Z00000X
GAOTA001348224Z00000X
WVC1778224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant