Provider Demographics
NPI:1265687891
Name:CHRISTOFFERSON, JENNIFER MECKES (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MECKES
Last Name:CHRISTOFFERSON
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 1:3110 KENTISH TOWN LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8084
Mailing Address - Country:US
Mailing Address - Phone:516-695-6279
Mailing Address - Fax:
Practice Address - Street 1:4709 CREEKSTONE DR STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-0016
Practice Address - Country:US
Practice Address - Phone:919-684-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014004-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist