Provider Demographics
NPI:1003589896
Name:CRAIG, JENNIFER ROS (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROS
Last Name:CRAIG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 CANTON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4515
Mailing Address - Country:US
Mailing Address - Phone:601-750-4493
Mailing Address - Fax:
Practice Address - Street 1:7712 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9299
Practice Address - Country:US
Practice Address - Phone:601-427-5775
Practice Address - Fax:601-206-0668
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1361225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics