Provider Demographics
NPI:1528697208
Name:THORNTON, JESSICA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 MERRITT RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3027
Mailing Address - Country:US
Mailing Address - Phone:650-387-3733
Mailing Address - Fax:
Practice Address - Street 1:322 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5318
Practice Address - Country:US
Practice Address - Phone:408-647-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist