Provider Demographics
NPI:1831575810
Name:BIERMA, JESSICA (COTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BIERMA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 R G DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:ROMANCE
Mailing Address - State:AR
Mailing Address - Zip Code:72136-7005
Mailing Address - Country:US
Mailing Address - Phone:501-831-5159
Mailing Address - Fax:
Practice Address - Street 1:1008 HIGHWAY 25B
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2034
Practice Address - Country:US
Practice Address - Phone:501-365-3927
Practice Address - Fax:501-365-3914
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A989224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210418721Medicaid