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NPI Code Detail

MEDICARE: MRS. JENNIFER BLACKSTONE OTR/L

MEDICARE: MRS. JENNIFER BLACKSTONE 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
1225X00000XOccupational TherapistOT003198GA

General Provider Information

NPI Number : 1669400917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER BLACKSTONE OTR/L
Provider Business Mailing Address
First Line : 2155 W PARK CT
Second Line : SUITE G/ H
City : STONE MOUNTAIN
State : GA
Zip : 30087-3500
Country : US
Telephone Number : 770-465-5084
Fax Number : 770-465-5304
Provider Business Practice Location Address
First Line : 2155 W PARK CT
Second Line : SUITE G/ H
City : STONE MOUNTAIN
State : GA
Zip : 30087-3500
Country : US
Telephone Number : 770-465-5084
Fax Number : 770-465-5304
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

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