Provider Demographics
NPI:1033200654
Name:VOORHEES, JENNIFER SHANA (OTR L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHANA
Last Name:VOORHEES
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SHANA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:3841 ORCHARD AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-537-0628
Mailing Address - Fax:
Practice Address - Street 1:900 WEST 94TH STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420
Practice Address - Country:US
Practice Address - Phone:952-885-0418
Practice Address - Fax:952-885-0173
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist