Provider Demographics
NPI:1073932745
Name:JENKINS, FAITH MARY (MSOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:MARY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:MISS
Other - First Name:FAITH
Other - Middle Name:MARY
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR/L
Mailing Address - Street 1:810 W 4TH ST UNIT 314
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2583
Mailing Address - Country:US
Mailing Address - Phone:336-529-0467
Mailing Address - Fax:
Practice Address - Street 1:801 MEADOWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2838
Practice Address - Country:US
Practice Address - Phone:336-285-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist