Healthcare Provider Details

I. General information

NPI: 1427280189
Provider Name (Legal Business Name): MS. JENNIFER MARIE CARTWRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 COLLEGE ST
SMITHS GROVE KY
42171-8240
US

IV. Provider business mailing address

990 COLLEGE ST
SMITHS GROVE KY
42171-8240
US

V. Phone/Fax

Practice location:
  • Phone: 419-852-7729
  • Fax:
Mailing address:
  • Phone: 419-852-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03978
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number201103672
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: