Provider Demographics
NPI:1811368798
Name:SIMPLER, JESSICA (OTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SIMPLER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SHOWALTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTA
Mailing Address - Street 1:3410 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3729
Mailing Address - Country:US
Mailing Address - Phone:903-792-3003
Mailing Address - Fax:903-794-1005
Practice Address - Street 1:3410 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3729
Practice Address - Country:US
Practice Address - Phone:903-792-3003
Practice Address - Fax:903-794-1005
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213073224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant