Provider Demographics
NPI:1619986171
Name:FORD, JENNIFER KAY (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:FORD
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 1:3810 NEW BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3213
Mailing Address - Country:US
Mailing Address - Phone:651-264-9814
Mailing Address - Fax:651-738-9889
Practice Address - Street 1:1687 WOODLANE DR STE 201
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3047
Practice Address - Country:US
Practice Address - Phone:651-264-9814
Practice Address - Fax:651-738-9889
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6406266OtherMEDICA PROVIDER NUMBER
WI41031600Medicaid
MN094H7FOOtherBCBS PROVIDER NUMBER
MN2442958OtherAMERICA'S PPO
MNHP61130OtherHEALTHPARTNERS