Provider Demographics
NPI:1427340322
Name:RIGGS, JESSICA BROOKE (MSOTR/L)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:BROOKE
Last Name:RIGGS
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 KRISTIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2251
Mailing Address - Country:US
Mailing Address - Phone:678-313-6608
Mailing Address - Fax:
Practice Address - Street 1:5991 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1342
Practice Address - Country:US
Practice Address - Phone:770-205-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist