Provider Demographics
NPI:1730209669
Name:HOWELL, JENNIFER L (OT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HOWELL
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 1:6114 GREENGATE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8252
Mailing Address - Country:US
Mailing Address - Phone:704-843-9066
Mailing Address - Fax:
Practice Address - Street 1:6114 GREENGATE LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8252
Practice Address - Country:US
Practice Address - Phone:704-843-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346635Medicare Oscar/Certification
SC426614Medicare Oscar/Certification