Provider Demographics
NPI:1972287142
Name:BLOCK, JENNIFER E (OTR/L, MSOT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:BLOCK
Suffix:
Gender:F
Credentials:OTR/L, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12961 MEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-3331
Mailing Address - Country:US
Mailing Address - Phone:502-751-5593
Mailing Address - Fax:
Practice Address - Street 1:6100 KENNERLY RD STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4379
Practice Address - Country:US
Practice Address - Phone:904-739-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist