Provider Demographics
NPI:1265538706
Name:BAYER, JENNIFER ANN (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BAYER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11490 ALPHARETTA HWY 200
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3866
Mailing Address - Country:US
Mailing Address - Phone:770-740-8592
Mailing Address - Fax:770-752-9478
Practice Address - Street 1:8501 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2046
Practice Address - Country:US
Practice Address - Phone:317-875-9105
Practice Address - Fax:317-875-8638
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003899A225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00703266OtherRR MEDICARE
000000384790OtherANTHEM HEALTH PLAN
IN200544840Medicaid
INP00703266OtherRR MEDICARE
IN062110J6Medicare PIN