Provider Demographics
NPI:1790973337
Name:ROBERTS, JESSICA R (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:O'NEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:7406 N 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7325 N 106TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1557
Practice Address - Country:US
Practice Address - Phone:402-499-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE498N2255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer