Provider Demographics
NPI:1306530449
Name:JESSEN, CHASITY
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:JESSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-7092
Mailing Address - Country:US
Mailing Address - Phone:870-378-8899
Mailing Address - Fax:
Practice Address - Street 1:567 US-67
Practice Address - Street 2:SUITE B
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455
Practice Address - Country:US
Practice Address - Phone:870-248-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2985225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist