Provider Demographics
NPI:1588276208
Name:YOCUM, JESSICA BROOKE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BROOKE
Last Name:YOCUM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:BROOKE
Other - Last Name:PARTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3902 SW BOULDER ST APT 27
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-8496
Mailing Address - Country:US
Mailing Address - Phone:479-530-6441
Mailing Address - Fax:
Practice Address - Street 1:3902 SW BOULDER ST APT 27
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-8496
Practice Address - Country:US
Practice Address - Phone:479-530-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1637224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty