Provider Demographics
NPI:1720619984
Name:WADLEY, JESSICA MEGAN (OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEGAN
Last Name:WADLEY
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 1:4816 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-7101
Mailing Address - Country:US
Mailing Address - Phone:970-316-2618
Mailing Address - Fax:
Practice Address - Street 1:2850 MCCLELLAND DR STE 3000I
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5206
Practice Address - Country:US
Practice Address - Phone:970-316-2618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006306225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist