Provider Demographics
NPI:1154770311
Name:RODGERS, JESSICA (MOT, LOTR)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MOT, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 WILLIE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:LA
Mailing Address - Zip Code:71336-5864
Mailing Address - Country:US
Mailing Address - Phone:318-789-5332
Mailing Address - Fax:
Practice Address - Street 1:991 WILLIE HILL RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:LA
Practice Address - Zip Code:71336-5864
Practice Address - Country:US
Practice Address - Phone:318-789-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
LAOTA.200221224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant