Provider Demographics
NPI:1235461567
Name:CUNNINGHAM, JENNIFER MATHIS (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MATHIS
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1119 OLD HUMBOLDT ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1752
Mailing Address - Country:US
Mailing Address - Phone:731-668-3888
Mailing Address - Fax:731-668-1666
Practice Address - Street 1:1119 OLD HUMBOLDT ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1752
Practice Address - Country:US
Practice Address - Phone:731-668-3888
Practice Address - Fax:731-668-1666
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN657225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist