MEDICARE: MRS. JARNETTA LATRICE FOWLER 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	OT00361	GA

General Provider Information

NPI Number	:	1912195967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JARNETTA LATRICE FOWLER OTR/L

Provider Business Mailing Address
First Line	:	3 WEXTON CT
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-7011
Country	:	US
Telephone Number	:	706-563-5873
Fax Number	:

Provider Business Practice Location Address
First Line	:	7909 MARNE RD. BLDG 9256
Second Line	:
City	:	FT MOORE
State	:	GA
Zip	:	31905-7011
Country	:	US
Telephone Number	:	706-626-2604
Fax Number	:

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	07/16/2024

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