Healthcare Provider Details

I. General information

NPI: 1205984713
Provider Name (Legal Business Name): MRS. JENNIFER LYNN WURZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 CARSON ST
HOT SPRINGS AR
71901-6852
US

IV. Provider business mailing address

111 PROSPECT AVE APT 52
HOT SPRINGS AR
71901-4099
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-6468
  • Fax:
Mailing address:
  • Phone: 501-620-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR 1788
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: