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General NPI Number Information
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NPI Number | 1225421738
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Entity Type | Individual
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Provider Name | JENNIFER GREGG
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Gender | Female
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Dates
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Enumeration Date | 03/08/2015
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Last Update Date | 03/08/2015
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Provider Practice Location Address
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Address Line | 1902 3RD AVE
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City | CANYON
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State | TX
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Zip | 79015-3031
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Country | US
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Telephone | 954-397-1021
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Fax | 806-557-4655
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Provider Business Mailing Address
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Address Line | 1902 3RD AVE
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City | CANYON
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State | TX
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Zip | 79015-3031
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Country | US
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Telephone | 954-397-1021
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Fax | 806-557-4655
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 209809
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License Number State | TX
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