Provider Demographics
NPI:1639068380
Name:QUEEN, JENNIFER JEANELL (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANELL
Last Name:QUEEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-1854
Mailing Address - Country:US
Mailing Address - Phone:731-217-5929
Mailing Address - Fax:
Practice Address - Street 1:61 POPLAR LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-1854
Practice Address - Country:US
Practice Address - Phone:731-217-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1556224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant