Provider Demographics
NPI:1881127579
Name:CARR-HERTEL, JENNIFER OLIVIA (EDD, MS, OTR/L)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:OLIVIA
Last Name:CARR-HERTEL
Suffix:
Gender:F
Credentials:EDD, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14915 SW 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2722
Mailing Address - Country:US
Mailing Address - Phone:305-984-6283
Mailing Address - Fax:954-982-2831
Practice Address - Street 1:14915 SW 35TH ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-2722
Practice Address - Country:US
Practice Address - Phone:305-984-6283
Practice Address - Fax:954-982-2831
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist