Provider Demographics
NPI:1265951909
Name:PULLIAM, JESSICA NICHOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICHOLE
Last Name:PULLIAM
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 1:112 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1715
Mailing Address - Country:US
Mailing Address - Phone:859-381-7184
Mailing Address - Fax:
Practice Address - Street 1:100 PARKWAY OFFICE CT STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7438
Practice Address - Country:US
Practice Address - Phone:919-239-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist