Provider Demographics
NPI:1275667594
Name:DUTKEWYCH, JENNA (OT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DUTKEWYCH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 COUNTRY VILLAGE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3142
Practice Address - Country:US
Practice Address - Phone:603-788-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist