Individual
JENNIFER MARIE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
3803 PEACHTREE AVE, WILMINGTON, NC 28403-6727
(910) 313-2111
Mailing address
3803 PEACHTREE AVE, WILMINGTON, NC 28403-6727
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
3496
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205H
BCBS PROVIDER NUMBER
NC
05
—
7301159
—
NC
Enumeration date
01/24/2007
Last updated
07/09/2007
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