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General NPI Number Information
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NPI Number | 1255798989
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Entity Type | Individual
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Provider Name | JENNIFER WADE O.T.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 808 S 52ND ST
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City | ROGERS
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State | AR
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Zip | 72758-8602
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Country | US
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Telephone | 479-587-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 3232 N NORTHHILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4005
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Country | US
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Telephone |
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OTR2857
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 06596
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12947
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License Number State | MA
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