Healthcare Provider Details

I. General information

NPI: 1912195967
Provider Name (Legal Business Name): JARNETTA LATRICE FOWLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VAN AALST BLVD
FT BENNING GA
31905-7011
US

IV. Provider business mailing address

3 WEXTON CT
COLUMBUS GA
31907-7011
US

V. Phone/Fax

Practice location:
  • Phone: 706-626-2604
  • Fax:
Mailing address:
  • Phone: 706-563-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00361
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: