Provider Demographics
NPI:1386959153
Name:CARLSON, JESSICA LYNNE (OTR)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNNE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 HABERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15211-2144
Mailing Address - Country:US
Mailing Address - Phone:412-979-7873
Mailing Address - Fax:
Practice Address - Street 1:475 E WATERFRONT DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1144
Practice Address - Country:US
Practice Address - Phone:412-394-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist