Provider Demographics
NPI:1912165069
Name:RECIO, JESSICA M
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:RECIO
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 1:835 N EXPRESSWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6831
Mailing Address - Country:US
Mailing Address - Phone:956-544-7722
Mailing Address - Fax:956-544-7728
Practice Address - Street 1:835 N EXPRESSWAY
Practice Address - Street 2:SUITE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6831
Practice Address - Country:US
Practice Address - Phone:956-544-7722
Practice Address - Fax:956-544-7728
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112656225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-4849OtherCMS
TX169033101Medicaid