Provider Demographics
NPI:1114431038
Name:MCDUFFEE, JENNA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:MCDUFFEE
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 1:192 LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076-3303
Mailing Address - Country:US
Mailing Address - Phone:860-930-2920
Mailing Address - Fax:
Practice Address - Street 1:484 RIDGEBURY RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-1228
Practice Address - Country:US
Practice Address - Phone:203-801-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12507225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist