Provider Demographics
NPI:1881216604
Name:BURRELL, JENIFER J (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:J
Last Name:BURRELL
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 1:4076 W SOLEDAD PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1307
Mailing Address - Country:US
Mailing Address - Phone:520-977-3698
Mailing Address - Fax:
Practice Address - Street 1:5151 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3705
Practice Address - Country:US
Practice Address - Phone:480-787-5387
Practice Address - Fax:866-701-4982
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-006945225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist