Provider Demographics
NPI:1295354090
Name:TRUITT, JENNIFER SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:TRUITT
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 1:1033 STRATUS DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7903
Mailing Address - Country:US
Mailing Address - Phone:814-221-7430
Mailing Address - Fax:
Practice Address - Street 1:415 PACE ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1246
Practice Address - Country:US
Practice Address - Phone:931-668-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000005712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist