Healthcare Provider Details

I. General information

NPI: 1821522418
Provider Name (Legal Business Name): JENNIFER HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 COLUMBIA 100 PKWY
COLUMBIA MD
21045-2361
US

IV. Provider business mailing address

4803 CIRCLING HUNTER DR APT 303
COLUMBIA MD
21045-2149
US

V. Phone/Fax

Practice location:
  • Phone: 877-776-8502
  • Fax:
Mailing address:
  • Phone: 410-456-9738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number02871
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: