Provider Demographics
NPI:1700213022
Name:LOCKETT, JENNIFER GRACE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GRACE
Last Name:LOCKETT
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 1:1267 CARNATION CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1546
Mailing Address - Country:US
Mailing Address - Phone:931-980-0366
Mailing Address - Fax:
Practice Address - Street 1:210 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6993
Practice Address - Country:US
Practice Address - Phone:931-538-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2675225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics