Provider Demographics
NPI:1851626709
Name:FIELDS, JESSICA LEE ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE ANN
Last Name:FIELDS
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 1:468 OVERLOOK TER
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-8660
Mailing Address - Country:US
Mailing Address - Phone:606-634-8942
Mailing Address - Fax:
Practice Address - Street 1:468 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-8660
Practice Address - Country:US
Practice Address - Phone:606-634-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist