Provider Demographics
NPI:1245761279
Name:PROCTOR, JENNIFER RICE (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RICE
Last Name:PROCTOR
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 1:476 COUNTY ROAD 228
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-6414
Mailing Address - Country:US
Mailing Address - Phone:256-242-3014
Mailing Address - Fax:
Practice Address - Street 1:476 COUNTY ROAD 228
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-6414
Practice Address - Country:US
Practice Address - Phone:256-242-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18303225X00000X
AL4853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist