Provider Demographics
NPI:1043562192
Name:HAUSCHILD, JENNIFER R (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:HAUSCHILD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:LINAFELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:13537 BARRETT PARKWAY DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5899
Mailing Address - Country:US
Mailing Address - Phone:314-821-9126
Mailing Address - Fax:314-821-9142
Practice Address - Street 1:1047 CENTURY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3772
Practice Address - Country:US
Practice Address - Phone:618-307-3434
Practice Address - Fax:618-307-3435
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056004839225X00000X
MO2012034579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL532400018Medicare PIN