Provider Demographics
NPI:1154704211
Name:BASSETT, JESSICA (MS, OTRL)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC
Mailing Address - State:MI
Mailing Address - Zip Code:48881-8617
Mailing Address - Country:US
Mailing Address - Phone:616-295-3356
Mailing Address - Fax:
Practice Address - Street 1:7210 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:SARANAC
Practice Address - State:MI
Practice Address - Zip Code:48881-8617
Practice Address - Country:US
Practice Address - Phone:616-295-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15-0550225X00000X
AZ6077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist