Individual
JENNIFER PETERSON POE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3837 CARDINAL OAKS CIR, ORANGE PARK, FL 32065-4251
(607) 339-6652
Mailing address
3837 CARDINAL OAKS CIR, ORANGE PARK, FL 32065-4251
(607) 339-6652
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
225X00000X
Occupational Therapist
Primary
OT16235
FL
225XP0200X
Pediatric Occupational Therapist
OT16239
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT16239
LICENSE NUMBER
FL
Enumeration date
08/13/2009
Last updated
02/22/2024
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