Provider Demographics
NPI:1265404545
Name:TRIVETTE, JENNIFER CARPENTER (OTRL)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:CARPENTER
Last Name:TRIVETTE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1087 13TH ST SE
Mailing Address - Street 2:CHILDRENS NEUROTHERAPY SERVICES
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4165
Mailing Address - Country:US
Mailing Address - Phone:828-267-1688
Mailing Address - Fax:828-267-1690
Practice Address - Street 1:1087 13TH ST SE
Practice Address - Street 2:CHILDRENS NEUROTHERAPY SERVICES
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4165
Practice Address - Country:US
Practice Address - Phone:828-267-1688
Practice Address - Fax:828-267-1690
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4754225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301825Medicaid
9299152OtherPHCS
NC140G1OtherBCBS
NC11230218OtherCAQH
NCE4050OtherMEDCOST