MEDICARE: MRS. JENNY EBORN MCNEILL 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	5975	NC

General Provider Information

NPI Number	:	1346482957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY EBORN MCNEILL OTR/L

Provider Business Mailing Address
First Line	:	405 WEST 15TH STREET
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3524
Country	:	US
Telephone Number	:	252-975-1992
Fax Number	:	252-975-3878

Provider Business Practice Location Address
First Line	:	405 WEST 15TH STREET
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3524
Country	:	US
Telephone Number	:	252-975-1992
Fax Number	:	252-975-3878

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	03/27/2009

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