Provider Demographics
NPI:1972622140
Name:FURNESS, JENIFER LEE (OTR, COF)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:LEE
Last Name:FURNESS
Suffix:
Gender:F
Credentials:OTR, COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 LILLIE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2040
Mailing Address - Country:US
Mailing Address - Phone:563-343-0852
Mailing Address - Fax:
Practice Address - Street 1:2123 LILLIE AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2040
Practice Address - Country:US
Practice Address - Phone:563-343-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
IL056.004970225X00000X
IA01130225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL264560645Medicaid
KY7100120570Medicaid
OH3053065Medicaid
OH3053065Medicaid