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Individual

MS. JENNIFER L WILD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
1483 SW BOUGAINVILLEA AVE, PORT SAINT LUCIE, FL 34953-7302
(772) 336-6928
Mailing address
10702 SW ELSINORE DR, PORT SAINT LUCIE, FL 34987-2149
(772) 336-6928

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT8477
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
884456900
FL
Enumeration date
04/05/2007
Last updated
01/22/2021
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