Provider Demographics
NPI:1043665698
Name:LISTHAUS, JESSICA KARYN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:KARYN
Last Name:LISTHAUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1905
Mailing Address - Country:US
Mailing Address - Phone:201-704-0468
Mailing Address - Fax:
Practice Address - Street 1:25 FAWN DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1905
Practice Address - Country:US
Practice Address - Phone:201-704-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist