Provider Demographics
NPI:1881852218
Name:MAULTSBY, JENNIE DAVIS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:DAVIS
Last Name:MAULTSBY
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 1:769 CHERAW RD
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-7158
Mailing Address - Country:US
Mailing Address - Phone:910-582-0021
Mailing Address - Fax:
Practice Address - Street 1:769 CHERAW RD
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-7158
Practice Address - Country:US
Practice Address - Phone:910-582-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist