Provider Demographics
NPI:1548497076
Name:WOODFORD, JENNIFER LOUISE (OT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:WOODFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 E LYNX WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8811
Mailing Address - Country:US
Mailing Address - Phone:480-227-9035
Mailing Address - Fax:
Practice Address - Street 1:1293 E LYNX WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-8811
Practice Address - Country:US
Practice Address - Phone:480-227-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist