Provider Demographics
NPI:1184782468
Name:NORTHCUT, JESSICA CATHERINE (MSOTRL)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CATHERINE
Last Name:NORTHCUT
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-2921
Mailing Address - Country:US
Mailing Address - Phone:423-266-2049
Mailing Address - Fax:
Practice Address - Street 1:5381 HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-2900
Practice Address - Country:US
Practice Address - Phone:706-657-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2796225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist