Individual
MRS. JESSICA B EASTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
310 E BROADWAY AVE STE 8, JACKSON, WY 83001-8636
(307) 413-8580
Mailing address
PO BOX 12438, JACKSON, WY 83002-2438
(307) 413-8580
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
642
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315436
BLUE CROSS/BLUE SHIELD
—
Enumeration date
04/23/2008
Last updated
03/13/2019
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