Provider Demographics
NPI:1013136365
Name:STEPHENSON, JENNIFER G (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:G
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7756 PRAIRIE VIEW LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3494
Mailing Address - Country:US
Mailing Address - Phone:317-585-1079
Mailing Address - Fax:
Practice Address - Street 1:7756 PRAIRIE VIEW LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3494
Practice Address - Country:US
Practice Address - Phone:317-585-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001961A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics