Basic Information
| Provider Information | |||||||||
| NPI: | 1528566957 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MOONEY | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14203 COUNTY ROAD 452 UNIT 3 | ||||||||
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| City: | LINDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757714210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035700247 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 18TH AVE | ||||||||
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| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806315134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703533370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2018 | ||||||||
| LastUpdateDate: | 01/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA.0000970 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 215506 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.