Individual
MRS. JESSICA A IDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
900 PROVIDENT DR, WARSAW, IN 46580-3252
(574) 371-2500
(574) 371-2779
Mailing address
900 PROVIDENT DR, WARSAW, IN 46580-3252
(574) 371-2500
(574) 371-2779
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001333A
IN
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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