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NPI Code Detail

MEDICARE: JORDAN FAITH JENNINGS

MEDICARE: JORDAN FAITH JENNINGS
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 Therapist

General Provider Information

NPI Number : 1922613306
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN FAITH JENNINGS
Provider Business Mailing Address
First Line : 2299 OAKMONT DR UNIT 4208
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-2557
Country : US
Telephone Number : 317-446-1997
Fax Number :
Provider Business Practice Location Address
First Line : 3305 E FRY BLVD
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-2990
Country : US
Telephone Number : 520-515-2739
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2020
Last Update Date : 09/11/2020

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