MEDICARE: JENNIFER JOERRES OTR

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	314000000X	Skilled Nursing Facility	111098	TX

General Provider Information

NPI Number	:	1174719066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOERRES OTR

Provider Business Mailing Address
First Line	:	4803 WHIRLWIND DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-3077
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 KELL BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76309-4936
Country	:	US
Telephone Number	:	940-696-2296
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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