Provider Demographics
NPI:1508226341
Name:SAWYER, JENNIFER ANN (MOT, OTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:SAWYER
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:HORINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR
Mailing Address - Street 1:5416 E MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:IN
Mailing Address - Zip Code:46182-9730
Mailing Address - Country:US
Mailing Address - Phone:317-512-9423
Mailing Address - Fax:
Practice Address - Street 1:5416 E MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:IN
Practice Address - Zip Code:46182-9730
Practice Address - Country:US
Practice Address - Phone:317-512-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005067A225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics