Provider Demographics
NPI:1386262699
Name:NEUWIRTH, JESSICA NICOLE (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:NEUWIRTH
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2626
Mailing Address - Country:US
Mailing Address - Phone:561-400-6150
Mailing Address - Fax:
Practice Address - Street 1:2833 EXECUTIVE PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3646
Practice Address - Country:US
Practice Address - Phone:954-353-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21011225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist