=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811203565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA A JENNINGS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2010
-----------------------------------------------------
Last Update Date | 08/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38130 PRETTY POND RD
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33540-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-783-3653
-----------------------------------------------------
Fax | 813-783-3674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38130 PRETTY POND RD
-----------------------------------------------------
City | ZEPHYRHILLS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33540-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-783-3653
-----------------------------------------------------
Fax | 813-783-3674
-----------------------------------------------------
=====================================================
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 | OT 14255
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------