Provider Demographics
NPI:1033319645
Name:HORNER, JENNIFER LYNN (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:HORNER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 891
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-0891
Mailing Address - Country:US
Mailing Address - Phone:574-862-1838
Mailing Address - Fax:
Practice Address - Street 1:2600 MOREHOUSE AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2552
Practice Address - Country:US
Practice Address - Phone:574-295-8800
Practice Address - Fax:574-295-8670
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001957A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist