Provider Demographics
NPI:1396246427
Name:TELFOR, JENNIFER MARGARET (OTL)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:TELFOR
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-8824
Mailing Address - Country:US
Mailing Address - Phone:269-945-2407
Mailing Address - Fax:269-945-5380
Practice Address - Street 1:2700 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-8824
Practice Address - Country:US
Practice Address - Phone:269-945-2407
Practice Address - Fax:269-945-5380
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI800851229Medicaid