Provider Demographics
NPI:1871874594
Name:ST. PETER, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ST. PETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04443-6315
Mailing Address - Country:US
Mailing Address - Phone:207-876-4635
Mailing Address - Fax:207-876-4363
Practice Address - Street 1:9 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:ME
Practice Address - Zip Code:04443-6315
Practice Address - Country:US
Practice Address - Phone:207-876-4635
Practice Address - Fax:207-876-4363
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
META2549224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant