Provider Demographics
NPI:1316281819
Name:HAMMONS, JENNIFER ELAINE-SWEENEY (COTA/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE-SWEENEY
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9414
Mailing Address - Country:US
Mailing Address - Phone:270-847-3281
Mailing Address - Fax:
Practice Address - Street 1:460 SOUTH COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:KY
Practice Address - Zip Code:42170
Practice Address - Country:US
Practice Address - Phone:270-529-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA2309224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant