Provider Demographics
NPI:1437143138
Name:ALBIN, JENNIFER (OTR)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ALBIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:121 HWY 491 W
Mailing Address - City:DOVE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:81324-0664
Mailing Address - Country:US
Mailing Address - Phone:970-677-2477
Mailing Address - Fax:866-427-8523
Practice Address - Street 1:121 HWY 491 WEST
Practice Address - Street 2:
Practice Address - City:DOVE CREEK
Practice Address - State:CO
Practice Address - Zip Code:81324
Practice Address - Country:US
Practice Address - Phone:970-677-2477
Practice Address - Fax:866-427-8523
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1040453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1040453OtherOTR LICENSE
CO93286724Medicaid
CO1040453OtherOTR LICENSE
COQ10306Medicare UPIN
COC529148Medicare PIN