Provider Demographics
NPI:1780263772
Name:GOFF, JESSICA BETH
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BETH
Last Name:GOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 MURRAYS NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-6665
Mailing Address - Country:US
Mailing Address - Phone:601-508-7756
Mailing Address - Fax:
Practice Address - Street 1:7812 MURRAYS NURSERY RD
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-6665
Practice Address - Country:US
Practice Address - Phone:601-508-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT-3832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist