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NPI Code Detail

MEDICARE: JENNA WYNN

MEDICARE: JENNA WYNN
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 Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113211OTHERNCSTATE OF NORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY

General Provider Information

NPI Number : 1336884675
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA WYNN
Provider Business Mailing Address
First Line : 1201 FIRST EDITION DR APT 1907
Second Line :
City : DURHAM
State : NC
Zip : 27703-0934
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2301 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27705-4699
Country : US
Telephone Number : 919-681-2030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2022
Last Update Date : 01/05/2026

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Directions to “ JENNA WYNN ” Practice Location

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