Provider Demographics
NPI:1356045900
Name:FULCOMER, JENNIFER KATE (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KATE
Last Name:FULCOMER
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 1:4841 SW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8451
Mailing Address - Country:US
Mailing Address - Phone:352-361-6065
Mailing Address - Fax:
Practice Address - Street 1:8449 SW HIGHWAY 200 STE 141
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9695
Practice Address - Country:US
Practice Address - Phone:352-254-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23974225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist