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General NPI Number Information
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NPI Number | 1053769802
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Entity Type | Individual
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Provider Name | JENNIFER STUCKEY MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 14421 METROPOLIS AVE SUITE 103
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City | FORT MYERS
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State | FL
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Zip | 33912-4323
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Country | US
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Telephone | 239-561-2778
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Fax | 239-561-8107
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Provider Business Mailing Address
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Address Line | 27290 HIGH SEAS LN
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4311
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Country | US
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Telephone | 954-806-3538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT14271
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatrics
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License Number | OT14271
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License Number State | FL
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