Healthcare Provider Details

I. General information

NPI: 1699039768
Provider Name (Legal Business Name): JENNIFER MAE HANDLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BEACH BLVD
JACKSONVILLE FL
32207-4764
US

IV. Provider business mailing address

13238 PECKY CYPRESS DR
JACKSONVILLE FL
32223-5024
US

V. Phone/Fax

Practice location:
  • Phone: 904-346-5100
  • Fax:
Mailing address:
  • Phone: 516-967-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number63 015327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: