Provider Demographics
NPI:1053989889
Name:ECHEGOYEN, JESSICA XIOMARA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:XIOMARA
Last Name:ECHEGOYEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-3021
Mailing Address - Country:US
Mailing Address - Phone:281-619-0320
Mailing Address - Fax:
Practice Address - Street 1:2235 CAMERON DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-3021
Practice Address - Country:US
Practice Address - Phone:281-619-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist