Provider Demographics
NPI:1396438925
Name:PIERCE, JESSICA LYNN-WAHL (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN-WAHL
Last Name:PIERCE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5072 95TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-9599
Mailing Address - Country:US
Mailing Address - Phone:320-250-1550
Mailing Address - Fax:
Practice Address - Street 1:1717 UNIVERSITY DR SE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-2023
Practice Address - Country:US
Practice Address - Phone:320-251-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201555224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant