Provider Demographics
NPI:1164315644
Name:MCIVER, JEANNIFER L (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:JEANNIFER
Middle Name:L
Last Name:MCIVER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CLIFFWELL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-5573
Mailing Address - Country:US
Mailing Address - Phone:919-273-7986
Mailing Address - Fax:
Practice Address - Street 1:611 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5715
Practice Address - Country:US
Practice Address - Phone:919-330-4069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist