Provider Demographics
NPI:1689703621
Name:LOCKARD, JENNIFER RENE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENE
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BOGLE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2850
Mailing Address - Country:US
Mailing Address - Phone:606-398-8234
Mailing Address - Fax:
Practice Address - Street 1:401 BOGLE ST STE 206
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2850
Practice Address - Country:US
Practice Address - Phone:606-398-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR-3259225X00000X
KY135507225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1783OtherCBIS BILLING PROVIDER ID