Provider Demographics
NPI:1962567560
Name:MIGLIORE, JENNIFER LAUREN (OT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAUREN
Last Name:MIGLIORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LAUREN
Other - Last Name:MIGLIORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:500 MEDICAL CENTER BLVD
Mailing Address - Street 2:SPORTS MEDICINE AND REHAB CTR
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:SPORTS MEDICINE AND REHAB CTR
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7694
Practice Address - Country:US
Practice Address - Phone:678-312-2803
Practice Address - Fax:770-682-2236
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003229225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics