Provider Demographics
NPI:1356529077
Name:SHULL, JENNIFER (OT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SHULL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4074 PALM PL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-5035
Mailing Address - Country:US
Mailing Address - Phone:954-384-0559
Mailing Address - Fax:
Practice Address - Street 1:4074 PALM PL
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-5035
Practice Address - Country:US
Practice Address - Phone:954-384-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist