Provider Demographics
NPI:1871821462
Name:MATTHEWS, JENNIFER IRENE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HACKAMORE RD
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8508
Mailing Address - Country:US
Mailing Address - Phone:802-223-1213
Mailing Address - Fax:
Practice Address - Street 1:71 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663-5644
Practice Address - Country:US
Practice Address - Phone:802-485-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist