=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043467319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ANN ADAIR OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2008
-----------------------------------------------------
Last Update Date | 09/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1310 SIDNEY ST
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72501-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-612-7200
-----------------------------------------------------
Fax | 870-612-7203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3222
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72503-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-217-1931
-----------------------------------------------------
Fax | 870-612-7203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OTR2196
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------