Provider Demographics
NPI:1154468544
Name:FELL, JENNIFER ROSE MARTIN (OTR,L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE MARTIN
Last Name:FELL
Suffix:
Gender:F
Credentials:OTR,L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR,L
Mailing Address - Street 1:3008 JOSHUA TREE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3453
Mailing Address - Country:US
Mailing Address - Phone:573-886-5551
Mailing Address - Fax:
Practice Address - Street 1:1600 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5844
Practice Address - Country:US
Practice Address - Phone:573-815-2734
Practice Address - Fax:573-815-2605
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist