Provider Demographics
NPI:1710159181
Name:SOUTH, JENNIFER L (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SOUTH
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 1:15871 NW DAIRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINS
Mailing Address - State:OR
Mailing Address - Zip Code:97133-6108
Mailing Address - Country:US
Mailing Address - Phone:503-647-5020
Mailing Address - Fax:503-647-5020
Practice Address - Street 1:15871 NW DAIRY CREEK RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINS
Practice Address - State:OR
Practice Address - Zip Code:97133-6108
Practice Address - Country:US
Practice Address - Phone:503-647-5020
Practice Address - Fax:503-647-5020
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR987014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist