Jessica Chance

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

004878 Issued in CT

Practice address

13 Park Lawn Dr
Bethel, CT 06801-1043

Phone

(203) 790-8520

Fax

(203) 790-8530

NPI assigned

Oct 13, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jessica Chance Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1073111027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 PARK LAWN DR",
            "city": "BETHEL",
            "state": "CT",
            "postal_code": "068011043",
            "telephone_number": "203-790-8520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 PARK LAWN DR",
            "city": "BETHEL",
            "state": "CT",
            "postal_code": "068011043",
            "telephone_number": "203-790-8520",
            "fax_number": "203-790-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANCE",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": "004878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jolene.gulla@preftherapy.com",
            "affiliation": "N",
            "address_1": "13 Park Lawn Dr",
            "city": "Bethel",
            "state": "CT",
            "country_code": "US",
            "postal_code": "068011043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CHANCE",
            "credential": "OTR",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Occupational Therapist in Bethel, CT
• Providers in Bethel, CT by specialty
• Occupational Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.