Individual
JESSICA PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
10095 BRICK CHURCH RD, CAMBRIDGE, OH 43725-8550
(740) 439-8977
Mailing address
2441 OHIO AVE, CAMBRIDGE, OH 43725-9122
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT011325
OCCUPATIONAL THERAPIST LICENSE
—
Enumeration date
03/23/2022
Last updated
03/23/2022
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