Provider Demographics
NPI:1528518610
Name:HERSCOTT, JESSICA L
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HERSCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BARTLETT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KITTERY POINT
Mailing Address - State:ME
Mailing Address - Zip Code:03905-5650
Mailing Address - Country:US
Mailing Address - Phone:207-200-1484
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:1 VARRELL LN STE 18
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1058
Practice Address - Country:US
Practice Address - Phone:207-200-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist