Provider Demographics
NPI:1003887241
Name:TRAVERS, JENNIFER C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:TRAVERS
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 1:3030 S JONES BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6792
Mailing Address - Country:US
Mailing Address - Phone:702-360-1137
Mailing Address - Fax:702-341-1511
Practice Address - Street 1:3030 S JONES BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6792
Practice Address - Country:US
Practice Address - Phone:702-360-1137
Practice Address - Fax:702-341-1511
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902FOtherBCBS
FL887439500Medicaid