Provider Demographics
NPI:1275884124
Name:MOFFITT, JENNIFER PRUGH (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PRUGH
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:BARBARA
Other - Last Name:PRUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:9843 LAGO DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2771
Mailing Address - Country:US
Mailing Address - Phone:561-596-9328
Mailing Address - Fax:
Practice Address - Street 1:1600 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-5727
Practice Address - Country:US
Practice Address - Phone:561-596-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist