Provider Demographics
NPI:1215635495
Name:CAIN, JESSICA EILEEN (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EILEEN
Last Name:CAIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:EILEEN
Other - Last Name:HUPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:629 PALACE LN
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2398
Mailing Address - Country:US
Mailing Address - Phone:937-657-4721
Mailing Address - Fax:
Practice Address - Street 1:6690 LIBERATION WAY
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-2532
Practice Address - Country:US
Practice Address - Phone:614-289-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-08981208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation