Provider Demographics
NPI:1750791075
Name:FREEMAN, JESSICA (OTR)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:FREEMAN
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 1:3550 HULEN ST
Mailing Address - Street 2:STE D
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6808
Mailing Address - Country:US
Mailing Address - Phone:817-377-2535
Mailing Address - Fax:817-292-0572
Practice Address - Street 1:300 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1956
Practice Address - Country:US
Practice Address - Phone:682-205-3340
Practice Address - Fax:682-205-3342
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115958225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics