Provider Demographics
NPI:1720786601
Name:LINE, JENNIFER DANIELLE (OTR)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DANIELLE
Last Name:LINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4696 FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3257
Mailing Address - Country:US
Mailing Address - Phone:954-261-7620
Mailing Address - Fax:
Practice Address - Street 1:4696 FRANCES DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3257
Practice Address - Country:US
Practice Address - Phone:954-261-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty