Provider Demographics
NPI:1962532960
Name:MATTOX, JENNIFER JO BRUNTON (OTR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO BRUNTON
Last Name:MATTOX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:BRUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4021 NW DONDEE LN
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2672
Mailing Address - Country:US
Mailing Address - Phone:785-286-4640
Mailing Address - Fax:
Practice Address - Street 1:2701 SW RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1536
Practice Address - Country:US
Practice Address - Phone:785-232-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01863225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics