Provider Demographics
NPI:1003947052
Name:SUTHERLAND, JENNIFER V (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:V
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:V
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:825 SUMMERWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-743-2824
Mailing Address - Fax:
Practice Address - Street 1:1004 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7200
Practice Address - Country:US
Practice Address - Phone:561-745-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2546225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist