Provider Demographics
NPI:1285292508
Name:COLE, JESSICA T-J (COTA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:T-J
Last Name:COLE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1367 S COUNTRY CLUB DR UNIT 1062
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5289
Mailing Address - Country:US
Mailing Address - Phone:860-514-8415
Mailing Address - Fax:
Practice Address - Street 1:2012 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7305
Practice Address - Country:US
Practice Address - Phone:480-983-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-046633224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant