Provider Demographics
NPI:1548303688
Name:BARTHOLOMEW, JENNIFER LAIRD (OTR)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAIRD
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:CASE
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21006 WILLS TRCE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5186
Mailing Address - Country:US
Mailing Address - Phone:662-471-8848
Mailing Address - Fax:
Practice Address - Street 1:21006 WILLS TRCE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5186
Practice Address - Country:US
Practice Address - Phone:662-471-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT0375225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO470912908Medicaid