Provider Demographics
NPI:1194842799
Name:ADAMS, JENNIFER M (OTRK)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OTRK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 SARASOTA CENTER BLVD
Mailing Address - Street 2:#101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-9385
Mailing Address - Country:US
Mailing Address - Phone:941-379-3725
Mailing Address - Fax:941-377-1131
Practice Address - Street 1:63 SARASOTA CENTER BLVD
Practice Address - Street 2:#101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9385
Practice Address - Country:US
Practice Address - Phone:941-379-3725
Practice Address - Fax:941-377-1131
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890757900Medicaid