Provider Demographics
NPI:1962686048
Name:EDDY, JESSICA E (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:E
Last Name:EDDY
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 1:57 MOUNT PLEASANT ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-1757
Mailing Address - Country:US
Mailing Address - Phone:617-842-3284
Mailing Address - Fax:
Practice Address - Street 1:57 MOUNT PLEASANT ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-1757
Practice Address - Country:US
Practice Address - Phone:617-842-3284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist