Provider Demographics
NPI:1043738271
Name:COLON, JENNIFER LISA (CTRS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LISA
Last Name:COLON
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LISA
Other - Last Name:SCANLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:RECREATION THERAPY 117C
Mailing Address - City:GAINSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:352-374-6094
Practice Address - Street 1:1601 SW ARCHER AVE
Practice Address - Street 2:
Practice Address - City:GAINSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCTRS63772225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist