Provider Demographics
NPI:1386467900
Name:FRYE, JESSICA (ITDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1525 BEL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3240
Mailing Address - Country:US
Mailing Address - Phone:850-225-8340
Mailing Address - Fax:
Practice Address - Street 1:1525 BEL AIRE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3240
Practice Address - Country:US
Practice Address - Phone:850-225-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist