Provider Demographics
NPI:1386428837
Name:UNDERWOOD, JENNIFER JOY (OT/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 SPADE RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8808
Mailing Address - Country:US
Mailing Address - Phone:740-972-3976
Mailing Address - Fax:
Practice Address - Street 1:12200 STRAUSSER ST NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9479
Practice Address - Country:US
Practice Address - Phone:740-972-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist