Provider Demographics
NPI:1285150540
Name:STACY, JESSICA GERMANY (OT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GERMANY
Last Name:STACY
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 BASE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-9168
Mailing Address - Country:US
Mailing Address - Phone:501-241-2080
Mailing Address - Fax:
Practice Address - Street 1:1414 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4352
Practice Address - Country:US
Practice Address - Phone:501-241-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225X00000X
AROTR3062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist