MEDICARE: MRS. JENNIFER ANNE DOXTATER 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	225XP0200X	Pediatric Occupational Therapist	012608-1	NY

General Provider Information

NPI Number	:	1548579360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANNE DOXTATER OTR/L

Provider Business Mailing Address
First Line	:	702 STEUBEN RD
Second Line	:
City	:	HERKIMER
State	:	NY
Zip	:	13350-1016
Country	:	US
Telephone Number	:	315-858-0610
Fax Number	:	315-858-2440

Provider Business Practice Location Address
First Line	:	93 MAIN ST
Second Line	:
City	:	RICHFIELD SPRINGS
State	:	NY
Zip	:	13439-4504
Country	:	US
Telephone Number	:	315-858-0610
Fax Number	:

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

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	09/28/2010

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