Individual
MISS JESSICA GROGAN
Active
Individual
MISS JESSICA GROGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003972A
IN
225XH1200X
Hand Occupational Therapist
31003972A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200837790
—
IN
01
—
31003972A
STATE LICENSE
IN
01
—
P00708058
RR MEDICARE
IN
Enumeration date
03/16/2006
Last updated
05/24/2024
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