MEDICARE: MRS. JENNIFER FERNANDES 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
1	225X00000X	Occupational Therapist	TO002612	NJ

General Provider Information

NPI Number	:	1598961492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER FERNANDES OTR

Provider Business Mailing Address
First Line	:	372 WHITE OAK RIDGE RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-1230
Country	:	US
Telephone Number	:	973-258-0930
Fax Number	:

Provider Business Practice Location Address
First Line	:	372 WHITE OAK RIDGE RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-1230
Country	:	US
Telephone Number	:	973-258-0930
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	09/23/2009

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