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General NPI Number Information
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NPI Number | 1790011211
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Entity Type | Individual
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Provider Name | JENNIFER NICOLE HORN O.T.D.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 620 N LAFAYETTE ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-1820
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Country | US
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Telephone | 615-579-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 620 N LAFAYETTE ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-1820
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Country | US
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Telephone | 615-579-0477
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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 | 3797
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | R4929
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License Number State | KY
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