Provider Demographics
NPI:1528307980
Name:JENNINGS, LAUREN ANNE (OTR/MS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OTR/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 E BETHLEHEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:IN
Mailing Address - Zip Code:47164-6977
Mailing Address - Country:US
Mailing Address - Phone:502-643-0826
Mailing Address - Fax:
Practice Address - Street 1:3028 E BETHLEHEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:IN
Practice Address - Zip Code:47164-6977
Practice Address - Country:US
Practice Address - Phone:502-643-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005396A172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker