Provider Demographics
NPI:1386336774
Name:STELL, JENNIFER LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:STELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 MINK AVE # 205
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6300
Mailing Address - Country:US
Mailing Address - Phone:843-252-0033
Mailing Address - Fax:
Practice Address - Street 1:5000 HIGHWAY 17 BYP S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4500
Practice Address - Country:US
Practice Address - Phone:843-252-0033
Practice Address - Fax:843-582-0259
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6820225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty