Provider Demographics
NPI:1427393495
Name:PUGH, JENNIFER A (OTR)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:PUGH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:ORTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:988 OAK RIDGE TPKE STE 100A
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6919
Practice Address - Country:US
Practice Address - Phone:865-425-4388
Practice Address - Fax:865-425-4677
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN02846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530537Medicaid
TN0677340001Medicare NSC