Healthcare Provider Details

I. General information

NPI: 1649677188
Provider Name (Legal Business Name): MRS. JENNIFER LEANN DIAMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JENNIFER LEANN DIAMOND BLACKBURN

II. Dates (important events)

Enumeration Date: 11/27/2014
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5738 HWY 25/70
MARSHALL NC
28753
US

IV. Provider business mailing address

210 CHARLES CT
DANDRIDGE TN
37725-3332
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-8400
  • Fax:
Mailing address:
  • Phone: 859-625-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8400
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6286
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: