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General NPI Number Information
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NPI Number | 1245810928
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Entity Type | Individual
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Provider Name | JENNIFER ANN DOUGLAS OT
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 3040 WOLF RIDGE CT
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City | NEW ALBANY
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State | IN
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Zip | 47150-9590
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Country | US
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Telephone | 812-989-6349
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Fax |
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Provider Business Mailing Address
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Address Line | 3040 WOLF RIDGE CT
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City | NEW ALBANY
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State | IN
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Zip | 47150-9590
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Country | US
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Telephone | 812-989-6349
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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 | 31007392A
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License Number State | IN
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