Provider Demographics
NPI:1629379003
Name:BALDWIN, JENNIE LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:LYNN
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:LYNN
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:1476 W GOVERNMENT ST STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3051
Practice Address - Country:US
Practice Address - Phone:601-914-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2044225X00000X
AROTR2175225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist