Provider Demographics
NPI:1447030036
Name:GARNER, JENNIFER LEIGH (RMP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEIGH
Last Name:GARNER
Suffix:
Gender:F
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27122 BOSSE DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-5811
Mailing Address - Country:US
Mailing Address - Phone:443-239-6457
Mailing Address - Fax:
Practice Address - Street 1:14350 SOLOMONS ISLAND RD S
Practice Address - Street 2:202 B
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-2068
Practice Address - Country:US
Practice Address - Phone:240-466-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR03265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist