Provider Demographics
NPI:1538874078
Name:SHOBER, JESSICA MAUREEN (MS OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAUREEN
Last Name:SHOBER
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 1:675 WILLOW VALLEY SQ
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4876
Mailing Address - Country:US
Mailing Address - Phone:717-464-7645
Mailing Address - Fax:717-464-6017
Practice Address - Street 1:900 WILLOW VALLEY LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9051
Practice Address - Country:US
Practice Address - Phone:717-464-6861
Practice Address - Fax:717-464-8444
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist