Healthcare Provider Details

I. General information

NPI: 1124523709
Provider Name (Legal Business Name): JENNIFER CLOUD MOT, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 E CARMEL DR STE 320
CARMEL IN
46032-3317
US

IV. Provider business mailing address

12969 E 131ST ST
FISHERS IN
46037-5911
US

V. Phone/Fax

Practice location:
  • Phone: 317-660-5737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31005061A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: