Provider Demographics
NPI:1952518961
Name:PERRY, JENNIFER JOAN (OTRL)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:PERRY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8993
Mailing Address - Country:US
Mailing Address - Phone:256-653-6641
Mailing Address - Fax:
Practice Address - Street 1:902 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4731
Practice Address - Country:US
Practice Address - Phone:919-934-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist