Provider Demographics
NPI:1154916112
Name:POTRAZ, JESSICA ROSE (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:POTRAZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ROSE
Other - Last Name:MARITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4237 W 219TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1811
Mailing Address - Country:US
Mailing Address - Phone:440-454-4305
Mailing Address - Fax:
Practice Address - Street 1:4237 W 219TH ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1811
Practice Address - Country:US
Practice Address - Phone:440-454-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist