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NPI Code Detail

MEDICARE: JENNIFER AGUSTIN CANARIA OTR/L

MEDICARE:   JENNIFER AGUSTIN CANARIA  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
1225X00000XOccupational TherapistOT.0005945CO

General Provider Information

NPI Number : 1225696420
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER AGUSTIN CANARIA OTR/L
Provider Business Mailing Address
First Line : 6120 FAXON CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-1839
Country : US
Telephone Number : 719-360-2804
Fax Number :
Provider Business Practice Location Address
First Line : 12105 AMBASSADOR DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-3642
Country : US
Telephone Number : 291-671-9602
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2019
Last Update Date : 06/03/2019

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Directions to “ JENNIFER AGUSTIN CANARIA OTR/L” Practice Location

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