Provider Demographics
NPI:1538343850
Name:HOMAN, JENNIFER MARY (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:HOMAN
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 1:345 BAYSHORE BLVD
Mailing Address - Street 2:UNIT 345
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2344
Mailing Address - Country:US
Mailing Address - Phone:813-361-6892
Mailing Address - Fax:
Practice Address - Street 1:345 BAYSHORE BLVD
Practice Address - Street 2:UNIT 345
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2344
Practice Address - Country:US
Practice Address - Phone:813-361-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist