Basic Information
| Provider Information | |||||||||
| NPI: | 1982897971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIGG | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | COTA/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GORDON | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherCredential: | COTA/L | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13 NORTHTOWN DR | ||||||||
| Address2: | TRINITY REHAB SUITE 110 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012069195 | ||||||||
| FaxNumber: | 6019578391 | ||||||||
| Practice Location | |||||||||
| Address1: | 13 NORTHTOWN DR | ||||||||
| Address2: | TRINITY REHAB SUITE 110 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012069195 | ||||||||
| FaxNumber: | 6019578391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | TA2034 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.