Provider Demographics
NPI:1386102945
Name:DIMMITT, JENNIFER (DT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DIMMITT
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 OSPREY DR E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8188
Mailing Address - Country:US
Mailing Address - Phone:765-414-1105
Mailing Address - Fax:
Practice Address - Street 1:4734 OSPREY DR E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8188
Practice Address - Country:US
Practice Address - Phone:765-414-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty