Individual
JESSICA ELIZABETH STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L CHT
Contact information
Practice address
961A SUNSET DR, HOLLISTER, CA 95023-5602
(831) 635-1135
Mailing address
961A SUNSET DR, HOLLISTER, CA 95023-5602
(831) 635-1135
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT 2693
CA
225XH1200X
Hand Occupational Therapist
2693
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT 2693
OT LICENSE
CA
01
—
ZZZ02630Z
MEDICARE PROVIDER NUMBER
CA
Enumeration date
07/18/2006
Last updated
12/16/2023
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