Provider Demographics
NPI:1538279229
Name:FITZPATRICK, JENNIFER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 SHARON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-8700
Mailing Address - Country:US
Mailing Address - Phone:405-623-9178
Mailing Address - Fax:
Practice Address - Street 1:14700 SHARON SPRINGS DR
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-8700
Practice Address - Country:US
Practice Address - Phone:405-623-9178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1593225X00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200273360AMedicaid
OKOT 1593OtherOKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK587OtherLICENSE #
OKOT 1593OtherOKLAHOMA STATE BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK200273360AMedicaid
OKOK404504Medicare PIN