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NPI Code Detail

MEDICARE: MS. JENNIFER L WILD OTR

MEDICARE: MS. JENNIFER L WILD OTR
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 TherapistOT8477FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396867750
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER L WILD OTR
Provider Business Mailing Address
First Line : 10702 SW ELSINORE DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34987-2149
Country : US
Telephone Number : 772-336-6928
Fax Number :
Provider Business Practice Location Address
First Line : 1483 SW BOUGAINVILLEA AVE
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34953-7302
Country : US
Telephone Number : 772-336-6928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2007
Last Update Date : 01/22/2021

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