Individual
JESSICA REVELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
734 MANCHESTER LOOP, FAIRBANKS, AK 99712-1120
(907) 388-4426
Mailing address
734 MANCHESTER LOOP, FAIRBANKS, AK 99712-1120
(907) 388-4426
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2019
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019
STATE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY BOARD COTA
AK
Enumeration date
06/25/2013
Last updated
06/25/2013
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