MEDICARE: JENNIFER WIGER FRIERSON 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	OT001582	GA

General Provider Information

NPI Number	:	1578646949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WIGER FRIERSON OTR/L

Provider Business Mailing Address
First Line	:	1180 PIN OAK CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-8093
Country	:	US
Telephone Number	:	770-887-5838
Fax Number	:	770-887-0768

Provider Business Practice Location Address
First Line	:	1180 PIN OAK CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-8093
Country	:	US
Telephone Number	:	770-887-5838
Fax Number	:	770-887-0768

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

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	07/09/2007

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