Provider Demographics
NPI:1336773266
Name:REDDY, JESSICA (MOTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MOTR/L, CLT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L, CLT
Mailing Address - Street 1:547 W PARK AVE APT D
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2666
Mailing Address - Country:US
Mailing Address - Phone:623-249-0238
Mailing Address - Fax:
Practice Address - Street 1:14595 W ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9700
Practice Address - Country:US
Practice Address - Phone:847-680-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009378225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist