Basic Information
| Provider Information | |||||||||
| NPI: | 1841758240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLUMMER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | DOREEN | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545A 10TH ST | ||||||||
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| City: | LINCOLN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626561910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178713063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 CASTLE MANOR DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626566006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177351507 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2019 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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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 | 057.005135 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.