Provider Demographics
NPI:1235476458
Name:MENARD, JENNIFER LEE (COTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:MENARD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SPRING ST
Mailing Address - Street 2:APT 1
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2342
Mailing Address - Country:US
Mailing Address - Phone:401-218-7881
Mailing Address - Fax:
Practice Address - Street 1:24 SPRING ST
Practice Address - Street 2:APT 1
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2342
Practice Address - Country:US
Practice Address - Phone:401-218-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00333224Z00000X
CT1259224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant