Individual
JENNA L THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
225 CROSSLAKE DR, EVANSVILLE, IN 47715-8198
(812) 471-6677
(812) 474-2296
Mailing address
7300 E INDIANA ST, SUITE 102, EVANSVILLE, IN 47715-2794
(812) 476-0409
(812) 476-1016
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005322A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000782655
BLUE CROSS BLUE SHIELD
IN
01
—
000000782963
BLUE CROSS BLUE SHIELD
IN
01
—
000000783241
BLUE SHIELD BLUE CROSS
IN
05
—
201107090
—
IN
Enumeration date
07/16/2012
Last updated
07/08/2014
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