=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649801515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER ELIZABETH KUMP OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2020
-----------------------------------------------------
Last Update Date | 01/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 W MAPLE ST
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87401-5631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-325-2910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7530 NYESVILLE RD
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17202-7319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-372-0280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT4252
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------