Jessica Kay Hutman

Individual provider Active NPI Occupational Therapy Assistant · Anna, IL

NPI 1104603679 · NPPES record last updated Sep 11, 2023

Key facts

NPI
1104603679
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
057.006031 (IL)
Practice address
315 Brady Mill Rd
Anna, IL 62906-2306
Phone
(618) 833-6343
NPI assigned
Sep 11, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
057.006031ILMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 057.006031 IL Yes

Addresses

Primary practice location

315 Brady Mill Rd
Anna, IL 62906-2306

Mailing address

1401 N State St
Marion, IL 62959-2989
Phone (618) 922-0548

Other providers in Anna, IL

All providers in Anna, IL · Occupational Therapy Assistant in Illinois

Sources for this page

Verify at the official NPI Registry.