Provider Demographics
NPI:1225114366
Name:YANCEY, JERRY ANNIE (MHS,OTR/L)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ANNIE
Last Name:YANCEY
Suffix:
Gender:F
Credentials:MHS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NATURE WALK PARKWAY
Mailing Address - Street 2:STE 101
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092
Mailing Address - Country:US
Mailing Address - Phone:904-230-7761
Mailing Address - Fax:904-230-7763
Practice Address - Street 1:111 NATURE WALK PARKWAY
Practice Address - Street 2:STE 101
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092
Practice Address - Country:US
Practice Address - Phone:904-230-7761
Practice Address - Fax:904-230-7763
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 10896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist