Provider Demographics
NPI:1285768275
Name:GOSSELIN, JENNIFER (MS OTR L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 OLDE MADBURY LANE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5443
Mailing Address - Country:US
Mailing Address - Phone:603-978-5467
Mailing Address - Fax:
Practice Address - Street 1:21 SEARLES ROAD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03807
Practice Address - Country:US
Practice Address - Phone:603-890-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU2543730601OtherCIGNA HEALTH CARE OAP