Provider Demographics
NPI:1942410675
Name:STATES, JENNIFER PAIGE (OTR)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PAIGE
Last Name:STATES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:P
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1214 CARDINAL CREST DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2470
Mailing Address - Country:US
Mailing Address - Phone:414-426-0992
Mailing Address - Fax:
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-772-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5481-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist