Provider Demographics
NPI:1548579360
Name:DOXTATER, JENNIFER ANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:DOXTATER
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 1:702 STEUBEN RD
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1016
Mailing Address - Country:US
Mailing Address - Phone:315-858-0610
Mailing Address - Fax:315-858-2440
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13439-4504
Practice Address - Country:US
Practice Address - Phone:315-858-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012608-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics