Provider Demographics
NPI:1821242645
Name:BUSCH, JENNIFER BETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name:BUSCH
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 1:102 TRENTON LN
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3563
Mailing Address - Country:US
Mailing Address - Phone:864-877-7064
Mailing Address - Fax:
Practice Address - Street 1:1807A E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3841
Practice Address - Country:US
Practice Address - Phone:864-442-7482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1016225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist