Provider Demographics
NPI:1649644220
Name:PHAM, JESSICA (OTR)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N COLLEGE DR
Mailing Address - Street 2:SUITE203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4614
Mailing Address - Country:US
Mailing Address - Phone:805-922-1724
Mailing Address - Fax:805-922-2765
Practice Address - Street 1:201 N COLLEGE DR STE 203
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4614
Practice Address - Country:US
Practice Address - Phone:805-922-1724
Practice Address - Fax:805-922-2765
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT15244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist