Provider Demographics
NPI:1447898606
Name:TRAN, JESSICA PALPAILIN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PALPAILIN
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 N BERKELEY LAKE RD NW APT 323
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1431
Mailing Address - Country:US
Mailing Address - Phone:413-992-7167
Mailing Address - Fax:
Practice Address - Street 1:7367 SPOUT SPRINGS RD STE 125
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5564
Practice Address - Country:US
Practice Address - Phone:770-965-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist