Provider Demographics
NPI:1841448099
Name:DAVIS, JENNIFER L (OTR)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:CANTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:104 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2428
Mailing Address - Country:US
Mailing Address - Phone:731-587-3422
Mailing Address - Fax:731-587-3424
Practice Address - Street 1:104 OXFORD ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2428
Practice Address - Country:US
Practice Address - Phone:731-587-3422
Practice Address - Fax:731-587-3424
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000000524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist