Provider Demographics
NPI:1083115786
Name:STUART, JENNI
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:
Last Name:STUART
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 1:1385 W VASSAR RD
Mailing Address - Street 2:
Mailing Address - City:REESE
Mailing Address - State:MI
Mailing Address - Zip Code:48757-9326
Mailing Address - Country:US
Mailing Address - Phone:989-284-1541
Mailing Address - Fax:
Practice Address - Street 1:915 N RIVER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-6831
Practice Address - Country:US
Practice Address - Phone:989-781-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI520100769225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty