Healthcare Provider Details

I. General information

NPI: 1841961497
Provider Name (Legal Business Name): JENNIFER THOMPSON NOWAKOWSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463380 STATE RD
YULEE FL
32097
US

IV. Provider business mailing address

40 CRESTVIEW TER
STRATHAM NH
03885-2203
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-8893
  • Fax:
Mailing address:
  • Phone: 406-581-9059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: