MEDICARE: JENNIFER ANSELMO 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	5485	NC

General Provider Information

NPI Number	:	1811314891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANSELMO OTR/L

Provider Business Mailing Address
First Line	:	708 HUNTINGTOWNE DR
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-3855
Country	:	US
Telephone Number	:	864-567-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W MARION ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-5338
Country	:	US
Telephone Number	:	704-476-8000
Fax Number	:

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

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/12/2026

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Directions to “ JENNIFER ANSELMO OTR/L” Practice Location

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