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NPI Code Detail

MEDICARE: MS. JENNIFER RICHMAN OTR/L

MEDICARE: MS. JENNIFER RICHMAN OTR/L
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
1225XM0800XMental Health Occupational Therapist010419NY
2225X00000XOccupational Therapist010419NY

General Provider Information

NPI Number : 1578874707
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER RICHMAN OTR/L
Provider Business Mailing Address
First Line : 777 HOOPES AVE APT G104
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83401-6079
Country : US
Telephone Number : 917-359-0673
Fax Number :
Provider Business Practice Location Address
First Line : 1460 ELK CREEK DR
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-8237
Country : US
Telephone Number : 917-359-0673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2010
Last Update Date : 09/22/2023

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