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NPI Code Detail

MEDICARE: JACELYN JENNINGS M.O.T

MEDICARE: JACELYN JENNINGS M.O.T
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 Therapist16674FL

General Provider Information

NPI Number : 1346631132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACELYN JENNINGS M.O.T
Provider Business Mailing Address
First Line : 23013 WESTCHESTER BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33980-8448
Country : US
Telephone Number : 941-625-1220
Fax Number :
Provider Business Practice Location Address
First Line : 23013 WESTCHESTER BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33980-8448
Country : US
Telephone Number : 941-625-1220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2015
Last Update Date : 02/15/2015

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