Provider Demographics
NPI:1720789076
Name:ISRAEL, JESSICA (COTA/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ISRAEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JAMES ST APT 9A
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2175
Mailing Address - Country:US
Mailing Address - Phone:919-630-8435
Mailing Address - Fax:
Practice Address - Street 1:300 JAMES ST APT 9A
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2175
Practice Address - Country:US
Practice Address - Phone:919-630-8435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15595224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant