Provider Demographics
NPI:1043559495
Name:ESTRADA, JENNIFER STANLEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:STANLEY
Last Name:ESTRADA
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 1:3864 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5535
Mailing Address - Country:US
Mailing Address - Phone:703-400-2759
Mailing Address - Fax:904-541-3294
Practice Address - Street 1:1215 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4631
Practice Address - Country:US
Practice Address - Phone:904-269-8922
Practice Address - Fax:904-541-3294
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist