Jennifer Anderson, OTRL
Individual provider Active NPI Occupational Therapist · Mystic, CT
NPI 1760508477 · NPPES record last updated Jul 13, 2022
Key facts
- NPI
- 1760508477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 005123 (CT)
- Practice address
- 475 High Street
Mystic, CT 06355-1707 - Phone
- (860) 536-6070
- Fax
- (860) 536-9480
- NPI assigned
- Mar 22, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250110001279 | CT | Practitioner - Occupational Therapist in Private Practice | 2264960897 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA00338 | RI | MD | Occupational Therapy Assistant |
| 005123 | CT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inspire Physical Therapy and Wellness, LLC | Current |
Accepting new patients |
Locations
1353 Gold Star Hwy
#213
Groton, CT 06340
Phone (401) 600-1683
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA00338 | RI | |
| Occupational Therapist | 225X00000X | 005123 | CT | Yes |
Addresses
Primary practice location
475 High Street
Mystic, CT 06355-1707
Mailing address
475 High Street
Mystic, CT 06355-1707
Phone (860) 536-6070
Other names
- Jennifer Graham
Other providers in Mystic, CT
- Christina Adams
- Sultan Ahamed
- Carolivette Wednesday Alamo
- Michael J Alger
- Align Therapy and Coaching LLC
- Neal Anderson
- Annette L Headley MD LLC
- Tina M Aspromonte-Weiss
- Harvey Wilfred Austin
- Autism Restwise LLC
All providers in Mystic, CT · Occupational Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.