Provider Demographics
NPI:1265627962
Name:HAYHURST, JESSICA JANE (MOT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:HAYHURST
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:
Other - Last Name:MORAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6249
Mailing Address - Country:US
Mailing Address - Phone:254-634-8505
Mailing Address - Fax:254-221-7710
Practice Address - Street 1:1102 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6249
Practice Address - Country:US
Practice Address - Phone:254-634-8505
Practice Address - Fax:254-221-7710
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112399225X00000X, 225XP0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program