Provider Demographics
NPI:1073976288
Name:VANTOL, JENNIFER (OTRL, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VANTOL
Suffix:
Gender:F
Credentials:OTRL, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6136 OAKHURST PARK DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:MI
Mailing Address - Zip Code:48701-9754
Mailing Address - Country:US
Mailing Address - Phone:989-233-6215
Mailing Address - Fax:
Practice Address - Street 1:6136 OAKHURST PARK DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:MI
Practice Address - Zip Code:48701-9754
Practice Address - Country:US
Practice Address - Phone:989-233-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI5201004409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst