Provider Demographics
NPI:1053955864
Name:DELVACCHIO, JESSICA L (DROT, OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:DELVACCHIO
Suffix:
Gender:F
Credentials:DROT, OTR/L
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DROT, OTR/L
Mailing Address - Street 1:PO BOX 5020
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5020
Mailing Address - Country:US
Mailing Address - Phone:701-857-5286
Mailing Address - Fax:701-857-5694
Practice Address - Street 1:101 3RD AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3880
Practice Address - Country:US
Practice Address - Phone:701-857-5286
Practice Address - Fax:701-857-5694
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist