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NPI Code Detail

MEDICARE: JENNICA A ELLIOTT OTR

MEDICARE: JENNICA A ELLIOTT 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
1225X00000XOccupational Therapist103107MN

General Provider Information

NPI Number : 1285806976
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNICA A ELLIOTT OTR
Provider Business Mailing Address
First Line : 200 LEWIS AVE S
Second Line : STE#210
City : WATERTOWN
State : MN
Zip : 55388-4545
Country : US
Telephone Number : 952-955-2242
Fax Number : 952-955-2010
Provider Business Practice Location Address
First Line : 200 LEWIS AVE S
Second Line : STE#210
City : WATERTOWN
State : MN
Zip : 55388-4545
Country : US
Telephone Number : 952-955-2242
Fax Number : 952-955-2010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2008
Last Update Date : 04/02/2008

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Directions to “ JENNICA A ELLIOTT OTR” Practice Location

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