Provider Demographics
NPI:1265825400
Name:MAXWELL, JESSICA T (PHD, OTD, OTR, CEAS)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:T
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PHD, OTD, OTR, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 GOODFELLA AVE
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-0198
Mailing Address - Country:US
Mailing Address - Phone:205-907-7768
Mailing Address - Fax:
Practice Address - Street 1:348 GOODFELLA AVE STE 240
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-0198
Practice Address - Country:US
Practice Address - Phone:205-907-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122789225XE1200X
TX122789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics