Healthcare Provider Details

I. General information

NPI: 1467492918
Provider Name (Legal Business Name): JENNIFER THOMPSON ADAMS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 GEORGETOWN RD NW SUITE 1
CLEVELAND TN
37312-2567
US

IV. Provider business mailing address

2303 CHESTNUT LN NW
CLEVELAND TN
37312-2135
US

V. Phone/Fax

Practice location:
  • Phone: 423-716-7183
  • Fax:
Mailing address:
  • Phone: 423-559-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT0000003384
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: