Provider Demographics
NPI:1023454808
Name:MCDONALD, JENNIFER MAUREEN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MAUREEN
Last Name:MCDONALD
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 1:10367 BOCA RATON DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2122
Mailing Address - Country:US
Mailing Address - Phone:410-799-8399
Mailing Address - Fax:
Practice Address - Street 1:2500 WALLINGTON WAY
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1505
Practice Address - Country:US
Practice Address - Phone:410-442-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05422225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist