Provider Demographics
NPI:1457747685
Name:ELLINGER, JESSICA (OTR/L CBIS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ELLINGER
Suffix:
Gender:F
Credentials:OTR/L CBIS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FLUEGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CBIS
Mailing Address - Street 1:3181 SANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9425
Mailing Address - Country:US
Mailing Address - Phone:517-336-6060
Mailing Address - Fax:517-336-6050
Practice Address - Street 1:3181 SANDHILL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9425
Practice Address - Country:US
Practice Address - Phone:517-336-6060
Practice Address - Fax:517-336-6050
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008424225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201008424OtherOCCUPATIONAL THERAPIST LICENSE
305197OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY