Provider Demographics
NPI:1174821193
Name:BAZLEY, JENNIFER (MOT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAZLEY
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 SPARROW BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5470
Mailing Address - Country:US
Mailing Address - Phone:904-230-9860
Mailing Address - Fax:
Practice Address - Street 1:ARISE PEDIATRIC REHABILITATION
Practice Address - Street 2:6817 SOUTHPOINT PARKWAY, SUITE 1602
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216
Practice Address - Country:US
Practice Address - Phone:904-945-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10031225X00000X
19584225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist