Provider Demographics
NPI:1700046653
Name:MUISE, JENNIFER SHIVERICK (OTR/L, LCSW, LCAS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHIVERICK
Last Name:MUISE
Suffix:
Gender:F
Credentials:OTR/L, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 WIDDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6699
Mailing Address - Country:US
Mailing Address - Phone:919-744-5342
Mailing Address - Fax:
Practice Address - Street 1:100 EASTOWNE DR FL 6
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2286
Practice Address - Country:US
Practice Address - Phone:984-974-6599
Practice Address - Fax:984-974-2680
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2152225X00000X
NCC0153771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist