Provider Demographics
NPI:1558019661
Name:MCKNIGHT, JENNIFER ELSNER (OTR/L, BCP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELSNER
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:OTR/L, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11462 LEATHERBACK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8038
Mailing Address - Country:US
Mailing Address - Phone:843-263-0973
Mailing Address - Fax:
Practice Address - Street 1:11462 LEATHERBACK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8038
Practice Address - Country:US
Practice Address - Phone:843-263-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2498225X00000X
FLOT18505225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist