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General NPI Number Information
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NPI Number | 1104302629
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Entity Type | Individual
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Provider Name | CHAD ALLEN JENNINGS MS,OTR
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Gender | Male
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 5610 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0500
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Country | US
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Telephone | 903-791-9355
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Fax | 855-218-5819
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Provider Business Mailing Address
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Address Line | 2226 SHADY PINES RD
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City | TEXARKANA
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State | TX
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Zip | 75501-8970
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Country | US
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Telephone | 903-748-3097
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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 | 110599
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License Number State | TX
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