Provider Demographics
NPI:1023105491
Name:DUNNELL, JENNIFER LYNN (MSOT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DUNNELL
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1955 E 7000 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121
Mailing Address - Country:US
Mailing Address - Phone:801-942-3311
Mailing Address - Fax:801-942-5955
Practice Address - Street 1:1111 W VICTORY WAY
Practice Address - Street 2:#103
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625
Practice Address - Country:US
Practice Address - Phone:970-824-9359
Practice Address - Fax:970-824-6777
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist