Provider Demographics
NPI:1962545723
Name:TOMS, JENNYFER L (OT, PTA)
Entity type:Individual
Prefix:
First Name:JENNYFER
Middle Name:L
Last Name:TOMS
Suffix:
Gender:F
Credentials:OT, PTA
Other - Prefix:
Other - First Name:JENNYFER
Other - Middle Name:L
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT, PTA
Mailing Address - Street 1:13691 METRO PKWY 400
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4349
Mailing Address - Country:US
Mailing Address - Phone:239-768-2272
Mailing Address - Fax:239-768-5549
Practice Address - Street 1:13691 METRO PKWY 120
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4348
Practice Address - Country:US
Practice Address - Phone:239-768-2272
Practice Address - Fax:239-768-5549
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA-18807225200000X
FLOT-11524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0865OtherMEDICARE GROUP
FL1962545723OtherCIGNA
FLK0865OtherMEDICARE GROUP