Provider Demographics
NPI:1821249483
Name:GAUNT, JODI (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:GAUNT
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:KOZLEVCAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 702
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2679
Mailing Address - Country:US
Mailing Address - Phone:615-724-4722
Mailing Address - Fax:615-577-5654
Practice Address - Street 1:1001 W 9TH AVE STE B&C
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1209
Practice Address - Country:US
Practice Address - Phone:610-831-1865
Practice Address - Fax:610-831-1865
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010836225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist