Provider Demographics
NPI:1164872073
Name:WOOD, JENNIFER-NICOLE LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER-NICOLE
Middle Name:LEE
Last Name:WOOD
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:2703 LEGENDS PKWY
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7755
Practice Address - Country:US
Practice Address - Phone:334-380-4930
Practice Address - Fax:205-803-6605
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist