Provider Demographics
NPI:1376622464
Name:DUTTON, JENNIFER MARION (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARION
Last Name:DUTTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARION
Other - Last Name:WILUSZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:806 NORTH MAIN STREET
Mailing Address - Street 2:BOOTHBY THERAPY SERVICES
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246
Mailing Address - Country:US
Mailing Address - Phone:603-524-9090
Mailing Address - Fax:603-524-1497
Practice Address - Street 1:806 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-524-9090
Practice Address - Fax:603-524-1497
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1439OtherNH OTR LICENSE