Organization · Type 2 NPI

Jelissa Nicole

Prosthetic/Orthotic Supplier · Dallas, TX

NPI number 1639769862 Active

Practice location

18880 Marsh Ln Apt 1902
Dallas, TX 75287-2241

Call (214) 497-8580 Map

Specialties and licenses

TaxonomyCodeLicense
Prosthetic/Orthotic Supplier Primary 335E00000XNone listed

Prosthetic/Orthotic Supplier: An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

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About NPI 1639769862

Jelissa Nicole's National Provider Identifier is 1639769862, issued on Jan 21, 2021. The primary taxonomy on file is Prosthetic/Orthotic Supplier (335E00000X), and the practice location is in Dallas, TX. The record was last updated on Jan 21, 2021.