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NPI Code Detail

MEDICARE: JENNIFER JAETZOLD

MEDICARE: JENNIFER JAETZOLD
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
1225X00000XOccupational Therapist111158TX

General Provider Information

NPI Number : 1285768895
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER JAETZOLD
Provider Business Mailing Address
First Line : 8430 BRITTANIA WAY
Second Line :
City : DALLAS
State : TX
Zip : 75243-8026
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 508 S ADAMS ST
Second Line : SUITE 102
City : FORT WORTH
State : TX
Zip : 76104-2147
Country : US
Telephone Number : 817-878-2834
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/08/2007

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Directions to “ JENNIFER JAETZOLD ” Practice Location

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