MEDICARE: JENNIFER-NICOLE LEE WOOD OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	4244	AL

General Provider Information

NPI Number	:	1164872073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER-NICOLE LEE WOOD OTR/L

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 LEGENDS PKWY
Second Line	:
City	:	PRATTVILLE
State	:	AL
Zip	:	36066-7755
Country	:	US
Telephone Number	:	334-380-4930
Fax Number	:	205-803-6605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	09/02/2021

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