MEDICARE: MRS. JENIFER A ANDERSON MS,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	5635	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0103C	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	64-42619	OTHER	NC	UHC

General Provider Information

NPI Number	:	1790754943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENIFER A ANDERSON MS,OTR/L

Provider Business Mailing Address
First Line	:	598 INDIAN TRAIL RD S STE 141
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-8689
Country	:	US
Telephone Number	:	704-975-7008
Fax Number	:	704-821-0750

Provider Business Practice Location Address
First Line	:	598 INDIAN TRAIL RD S STE 141
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-8689
Country	:	US
Telephone Number	:	704-975-7008
Fax Number	:	704-821-0750

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	07/17/2009

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