Provider Demographics
NPI:1184325847
Name:BARCZAK, JESSICA A (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BARCZAK
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 1:320 W BROADWAY APT 101
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3809
Mailing Address - Country:US
Mailing Address - Phone:262-391-4419
Mailing Address - Fax:
Practice Address - Street 1:1223 MADISON ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2629
Practice Address - Country:US
Practice Address - Phone:920-885-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI820226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist