Provider Demographics
NPI:1982059911
Name:DISON, JESSICA (COTA/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DISON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 CALGARY DR
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-3572
Mailing Address - Country:US
Mailing Address - Phone:865-254-3402
Mailing Address - Fax:
Practice Address - Street 1:7112 CALGARY DR
Practice Address - Street 2:
Practice Address - City:CORRYTON
Practice Address - State:TN
Practice Address - Zip Code:37721-3572
Practice Address - Country:US
Practice Address - Phone:865-254-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2484224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant