Provider Demographics
NPI:1659620276
Name:MEYER, JENNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MEYER
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 1:6103 S COURSE VW
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6113
Mailing Address - Country:US
Mailing Address - Phone:913-653-7857
Mailing Address - Fax:
Practice Address - Street 1:615 BAKERS BRIDGE AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1801
Practice Address - Country:US
Practice Address - Phone:913-653-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026704225X00000X
KS17-02806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist