Provider Demographics
NPI:1871840181
Name:MOK, JESSICA JESSICA WING (OT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JESSICA WING
Last Name:MOK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 AQUARIUS WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1939
Mailing Address - Country:US
Mailing Address - Phone:510-388-3664
Mailing Address - Fax:510-740-3491
Practice Address - Street 1:1037 AQUARIUS WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1939
Practice Address - Country:US
Practice Address - Phone:510-388-3664
Practice Address - Fax:510-740-3491
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11902225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist