Provider Demographics
NPI:1316262843
Name:DEINES, JESSICA R (OTR)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:DEINES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:SPROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:13405 W 56TH PL
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-4634
Mailing Address - Country:US
Mailing Address - Phone:913-904-2241
Mailing Address - Fax:
Practice Address - Street 1:3001 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2815
Practice Address - Country:US
Practice Address - Phone:913-904-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02587225X00000X
MO2009013185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist