MEDICARE: JENNIFER WITT-FRALEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	135517	KY

General Provider Information

NPI Number	:	1124547799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WITT-FRALEY

Provider Business Mailing Address
First Line	:	108 ADAMS RIDGE RD
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41701-9445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 PARK AVE
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41701-9548
Country	:	US
Telephone Number	:	606-439-2306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	10/03/2023

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