MEDICARE: JENNYFER L TOMS OT, PTA

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	225200000X	Physical Therapy Assistant	PTA-18807	FL
2	225X00000X	Occupational Therapist	OT-11524	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K0865	OTHER	FL	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1962545723	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1962545723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNYFER L TOMS OT, PTA

Provider Business Mailing Address
First Line	:	13691 METRO PKWY 400
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4349
Country	:	US
Telephone Number	:	239-768-2272
Fax Number	:	239-768-5549

Provider Business Practice Location Address
First Line	:	13691 METRO PKWY 120
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4348
Country	:	US
Telephone Number	:	239-768-2272
Fax Number	:	239-768-5549

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/27/2015

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Directions to “ JENNYFER L TOMS OT, PTA” Practice Location

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