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Individual
MRS. JESSICA ANNE BLACK
Active
Individual
MRS. JESSICA ANNE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005917A
IN
225X00000X
Occupational Therapist
5296
NC
225XH1200X
Hand Occupational Therapist
5296
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555850076
MEDICARE PTAN
IN
01
—
P00263219
RAILROAD MEDICARE
—
Enumeration date
04/08/2006
Last updated
04/07/2016
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