Healthcare Provider Details

I. General information

NPI: 1811314891
Provider Name (Legal Business Name): JENNIFER ANSELMO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MARION ST
SHELBY NC
28150-5338
US

IV. Provider business mailing address

708 HUNTINGTOWNE DR
KINGS MOUNTAIN NC
28086-3855
US

V. Phone/Fax

Practice location:
  • Phone: 704-476-8000
  • Fax:
Mailing address:
  • Phone: 864-567-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5485
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: