Provider Demographics
NPI:1609687920
Name:BOHNERT, JESSICA L (OTR)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:BOHNERT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E MARGARET DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3340
Mailing Address - Country:US
Mailing Address - Phone:812-264-1395
Mailing Address - Fax:
Practice Address - Street 1:1329 2ND ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1009
Practice Address - Country:US
Practice Address - Phone:765-231-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics