Healthcare Provider Details

I. General information

NPI: 1588856090
Provider Name (Legal Business Name): JENNIFER T HURLEY OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 MATTHEW DR SEDALIA 200
SEDALIA MO
65301-7981
US

IV. Provider business mailing address

2806 MATTHEW DR
SEDALIA MO
65301-7981
US

V. Phone/Fax

Practice location:
  • Phone: 660-829-6471
  • Fax: 660-826-1020
Mailing address:
  • Phone: 660-829-6471
  • Fax: 660-826-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: