MEDICARE: MRS. JENNIFER LEIGH ACKLIN MS 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
1	225X00000X	Occupational Therapist	OTR2016	AR

General Provider Information

NPI Number	:	1942559935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEIGH ACKLIN MS OTR/L

Provider Business Mailing Address
First Line	:	2419 STONEY CREEK DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4058
Country	:	US
Telephone Number	:	501-312-1277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2419 STONEY CREEK DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-4058
Country	:	US
Telephone Number	:	501-312-1277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	02/16/2013

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