Jessica Fortner, OTR/L
Individual provider Active NPI Specialist · Water Valley, MS
NPI 1104100130 · NPPES record last updated Oct 10, 2011
Key facts
- NPI
- 1104100130
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- OT2111 (MS)
- Practice address
- 194 County Road 371
Water Valley, MS 38965-3998 - Phone
- (662) 607-0111
- NPI assigned
- Oct 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT2111 | MS | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | OT2111 | MS | Yes |
Addresses
Primary practice location
194 County Road 371
Water Valley, MS 38965-3998
Mailing address
194 County Road 371
Water Valley, MS 38965-3998
Phone (662) 607-0111
Other providers in Water Valley, MS
- Family Health Care Clinic, Inc.
- Family Practice Clinic of Water Valley
- Family Practice Clinic of Water Valley
- Taylor Robertson Faulkner
- Cody Elizabeth Field
- Cinnamon Caryl Foster
- Angela Furlong
- Elizabeth A Gochnour
- Ashley Marie Griffith
- Lawanda Herron
All providers in Water Valley, MS · Specialist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.