Healthcare Provider Details

I. General information

NPI: 1851623953
Provider Name (Legal Business Name): JENNIFER L LAWRENCE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 DEWEY ST
BENNINGTON VT
05201-2225
US

IV. Provider business mailing address

332 DEWEY ST
BENNINGTON VT
05201-2225
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-6314
  • Fax: 802-447-1686
Mailing address:
  • Phone: 802-442-6314
  • Fax: 802-447-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072-0000079
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: