Provider Demographics
NPI:1851723027
Name:TALLENT, JESSICA L (MOT OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:TALLENT
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14557 W INDIAN SCHOOL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-229-7808
Mailing Address - Fax:
Practice Address - Street 1:14557 W INDIAN SCHOOL RD STE 500
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-229-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist