Provider Demographics
NPI:1982005476
Name:HEDRICK, JENIFER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:
Last Name:HEDRICK
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 1:1442 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:27299-9075
Mailing Address - Country:US
Mailing Address - Phone:586-242-1934
Mailing Address - Fax:
Practice Address - Street 1:1442 WILSON RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NC
Practice Address - Zip Code:27299-9075
Practice Address - Country:US
Practice Address - Phone:586-242-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist