Provider Demographics
NPI:1033322201
Name:GARCIA, JENNIFER J (OTRL)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:GARCIA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:11012 MILL CREEK WAY
Mailing Address - Street 2:2203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6669
Mailing Address - Country:US
Mailing Address - Phone:904-501-4617
Mailing Address - Fax:
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3118
Practice Address - Country:US
Practice Address - Phone:866-416-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist