Provider Demographics
NPI:1356518476
Name:DRAYER, JESSICA LEANNE (COTA/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEANNE
Last Name:DRAYER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 CARLISLE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2736
Mailing Address - Country:US
Mailing Address - Phone:937-307-7655
Mailing Address - Fax:
Practice Address - Street 1:6276 LONDON PLATTSBURG RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-8801
Practice Address - Country:US
Practice Address - Phone:937-408-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.03354224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant