Provider Demographics
NPI:1053737528
Name:REINHEARDT, JESSICA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:REINHEARDT
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 1:328 DAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LANDIS
Mailing Address - State:NC
Mailing Address - Zip Code:28088-1162
Mailing Address - Country:US
Mailing Address - Phone:980-622-0244
Mailing Address - Fax:
Practice Address - Street 1:707 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3917
Practice Address - Country:US
Practice Address - Phone:336-885-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7918224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant