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General NPI Number Information
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NPI Number | 1508092453
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Entity Type | Individual
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Provider Name | JENNIFER DAWN WAID OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 8045 PROVIDENCE RD SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-8745
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Country | US
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Telephone | 704-540-5252
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Fax | 704-540-5755
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Provider Business Mailing Address
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Address Line | 8045 PROVIDENCE RD SUITE 200
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City | CHARLOTTE
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State | NC
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Zip | 28277-8745
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Country | US
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Telephone | 704-540-5252
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Fax | 704-540-5755
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 2748
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License Number State | NC
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