Provider Demographics
NPI:1528074440
Name:HENDERSON, JENNIFER H (OT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:H
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HALPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:756 RIDGE LAKE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9420
Mailing Address - Country:US
Mailing Address - Phone:901-767-3667
Mailing Address - Fax:901-767-3669
Practice Address - Street 1:756 RIDGE LAKE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9420
Practice Address - Country:US
Practice Address - Phone:901-767-3667
Practice Address - Fax:901-767-3669
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3645547Medicare ID - Type Unspecified