Provider Demographics
NPI:1649549478
Name:OFFILL, JESSICA (PT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:OFFILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-9458
Mailing Address - Country:US
Mailing Address - Phone:859-823-0406
Mailing Address - Fax:859-823-0458
Practice Address - Street 1:201 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-9458
Practice Address - Country:US
Practice Address - Phone:859-823-0406
Practice Address - Fax:859-823-0458
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005931225100000X
OH013362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist